Clinical efficacy and safety of pembrolizumab and nivolumab in frontline treatment for classical Hodgkin lymphoma: systematic review and meta-analysis of clinical trials

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Introduction: Treatment of classical Hodgkin lymphoma (cHL) underwent substantial advances throughout the last decades, where PD-1 inhibitors showed improved clinical outcomes, leading to their approval for relapsed and refractory disease. Recent studies showed benefit in utilizing these agents in first-line settings. Recent studies showed benefit in utilizing these agents in first-line settings. This meta-analysis investigates clinical efficacy and safety of pembrolizumab and nivolumab for frontline cHL treatment. Methods: A comprehensive literature search was conducted through PubMed, EBSCO Host, and CENTRAL using relevant keywords. Full-text publications in the English language of clinical trials were selected. Complete response rate (CRR), overall response rate (ORR), 2-year overall survival (OS), 2-year progression-free survival (PFS), and grade ≥3 adverse events (AEs) were evaluated for pooled analysis. Results: Nine trials, including 880 patients with previously untreated cHL (21% with early-stage disease) with a median age of 34 years and a median follow-up of 31.2 months, were analyzed. Pooled data in all treatments revealed ORR 86% (95% confidence interval (CI), 59-96%), CRR 57% (95% CI, 62-97%), 2-year PFS 90% (95% CI, 70-97%), and 2-year OS 97% (95% CI, 91%-99%). Forty-one percent of patients (95% CI, 21-64%) experienced grade ≥3 AEs, and 17% (95% CI, 6-38%) grade ≥3 immune-related AEs in all treatment groups. AVD with pembrolizumab or nivolumab showed comparable efficacy (2-year PFS: 97% (95% CI, 88-99%) vs 92% (95% CI, 89-94%), 2-year OS: 98% (95% CI, 88%-100%) vs 99% (95% CI, 99-100%) and safety (grade ≥3 AEs: 36% vs 33%), respectively. Nivolumab with brentuximab vedotin had worse outcomes (2-year PFS 80%, OS 87%, and grade ≥3 AEs 79%), likely due to an older study population (median age 71.5 years). Conclusions: Adoption of nivolumab or pembrolizumab combinations in frontline treatment for cHL is a valid strategy for advanced disease or patients who are unfit or not interested in intensive cytotoxic chemotherapy regimens.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.