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Emerging Therapies in Hodgkin’s Lymphoma Management – Treatment Beyond The Basics
Moderator: Dr. Miriam Mutebi
Sponsor: Takeda, a pharmaceutical company with a patient assistance program for Hodgkin’s lymphoma in Kenya.
- Dr. Anna Sureda, Head of the Clinical Hematology Department and the Stem Cell Transplantation program of Institut Catala d’Oncologia – Hospitalet, Barcelona
Hodgkin’s lymphoma (HL) is one of the most curable hematological malignancies with first-line treatment, which is a combination of radiotherapy and chemotherapy. Autologous hematopoietic stem cell transplantation (auto-HCT) is the standard therapy for HL patients relapsing after first-line chemotherapy. The use of allogeneic stem cell transplantation (ASCT) has improved the overall survival (OS) of patients over time. To improve the landscape of chemotherapy treatment for refractory disease, a new drug, Brentuximab vedotin, has been introduced. This drug is an antibody-drug conjugate (ADC) consisting of 3 components; it binds to CD30 forming a complex that is internalized and traffics to the lysosome. The drug was granted accelerated approval by the US FDA in 2011. The European Medicines Agency (EMA) approved this drug in 2012 for the treatment of adult patients with relapsed or refractory CD30+ HL, anaplastic large cell lymphoma, and those at increased risk of relapse or progression following ASCT. The efficacy reported as median observation time from the first dose at study closure was 35.1 months (1.8-72.9). Studies revealed that Brentuximab vedotin and ESHAP are highly effective as second-line therapy for Hodgkin’s patients. Brentuximab vedotin was the first targeted therapy that was tested in patients with relapsed/refractory HL. It was very effective as a single drug in patients that relapse or progress after auto-HCT. Brentuximab vedotin is able to potentially increase the number of patients that are candidates to auto-HCT. It improves progression-free survival (PFS) in those patients with a high risk of relapse after auto-HCT when used as a consolidation strategy. It has demonstrated an adequate and safe toxicity profile, even in HIV-positive patients with HL. Brentuximab vedotin is being used in other settings with very interesting results (RR setting in combination with chemotherapy, first line). However, the cost of the treatment in Kenya is quite high; a single vial costs Kshs. 330,000. A patient assistance program in partnership with Takeda is helping patients in Kenya who cannot afford to pay, to complete their treatment. Although this program is run in private hospitals, physicians seeing patients at public facilities can refer the patients to the private facilities for assistance, but continue to follow up on the patients.