Side Effects and Supportive Care in Relapsed or Refractory Classical Hodgkin Lymphoma Patients Treated in Later Lines of Therapy: A Pilot Analysis Conducted in 4 Countries
Notice bibliographique
Résumé
Abstract Introduction: Most patients with classical Hodgkin lymphoma (cHL) can be cured with first-line multiagent chemotherapy. However, up to 20% require second-line (2L) therapy, including autologous hematopoietic cell transplantation (auto-HCT); 50% of those will develop relapsed/refractory cHL (R/R HL) after 2L therapy. The introduction of brentuximab vedotin (BV) in 2011 has changed the management of patients with R/R HL. The European Medicines Agency approved programmed death-1 (PD-1) inhibitor nivolumab (nivo) in 2016 for the treatment of patients with R/R HL who failed auto-HCT and BV and pembrolizumab (pembro) in 2017 for the treatment of R/R HL patients who failed auto-HCT and BV or who are transplant-ineligible and have failed BV. Both agents have improved clinical outcomes for indicated patients. As a pilot analysis, we assessed side effects and supportive care to manage side effects in patients with R/R HL who were treated with BV, nivo, or pembro in third- (3L) or later lines of therapy in real-world practice. Methods: The study was designed as a multicenter, cross-sectional survey of R/R HL patients receiving 3L or later-line systemic drug treatment, and was administered between June and September 2016 in Canada and 3 European countries (France, Germany, and UK). The study consisted of 2 components, a physician survey and a medical chart review; data captured included demographics and patient characteristics, treatment and disease management, clinical outcomes, and resource utilization. Side effects and supportive care were assessed during treatment. Summary statistics were reported and difference between treatment cohorts assessed using t -tests and Kruskal-Wallis tests for continuous variables and chi-square/Fisher exact tests for categorical variables. P value Results: A total of 116 physicians (Canada, 16; France, 31; Germany, 44; UK, 25) provided information on 955 patients with R/R HL who were treated in 3L or later-line therapy. Among these, 452 patients received exclusively BV, nivo, or pembro in 3L or later lines (median age 52 years; 58% male) and there was no overlap in utilization of the 3 agents. The 452 patients were divided into 3 treatment cohorts: 336 (74%) on BV, 90 (20%) on nivo, and 26 (6%) on pembro; these were mutually exclusive. Patients in the 3 cohorts were similar in terms of age, sex, most recent cancer stage, and performance status at study enrollment (Table). There was no statistically significant difference between cohorts in proportion of patients with bulky disease. Compared with those on BV, patients on nivo or pembro were more likely to be tested for Epstein-Barr virus (EBV)-specific antibodies (p=0.0003); among those tested, the proportions of patients with positive results were similar across cohorts (Table). The data suggest that nivo may generally result in fewer side effects than pembro and BV (Table). Pairwise comparisons between nivo and pembro show that nivo was associated with lower incidence of anemia (3.3% vs 15.4%, p=0.0438), diarrhea (2.2% vs 23.1%, p=0.0015), fatigue (3.3% vs 15.4%, p=0.0438), nausea (4.4% vs 26.9%, p=0.0024), vomiting (1.1% vs 26.9%, p Conclusions: The sample size of patients receiving nivo or pembro in this analysis is small, but preliminary analysis indicates that patients treated with nivo may have fewer side effects and require less supportive care than those receiving BV or pembro. Further analysis may be necessary to validate these findings. Study support: Bristol-Myers Squibb. Download : Download high-res image (226KB) Download : Download full-size image Disclosures Chen: Bristol-Myers Squibb: Employment. Byrne: Adelphi Real World: Employment. Hallworth: Adelphi Real World: Employment. Yasenchak: Bristol-Myers Squibb: Consultancy; Seattle Genetics: Consultancy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».