Keytruda became a new breakthrough in the tx

of Hodgkin's lymphoma after transplantation

[Interview] Yoon Duk-hyun, Professor of Oncology at AMC

From March, patients who have relapsed or cannot be transplanted can be reimbursed

Excellent effectiveness and drug resistance compared to standard treatment

MSD's Keytruda succeeded in applying Hodgkin's lymphoma benefit for the second time as an immuno-cancer drug.

 

Takeda is considered the best option for Hodgkin's lymphoma treatment.

 

It is evaluated as suitable as a new option by proving superiority through comparative clinical trials with Takeda's Adcetris.

 

As of March 1, Keytruda was reimbursed as a second or more treatment if it recurred or progressed after self-hematopoietic stem cell transplantation (ASCT) in typical Hodgkin lymphoma, and a third or more treatment if self-hematopoietic stem cell transplantation is impossible.

 

Yoon Deok-hyun, a professor of oncology at Asan Medical Center in Seoul, commented on the expansion of the benefit, "Keytruda showed superior effect than Adcetris in most Hodgkin lymphoma patients, so Keytruda will be used first unless it is an exception." Hodgkin's lymphoma is mostly young patients, with people in their 20s and 30s accounting for 80% of the total.

 

Lymphoma can occur in T lymphocytes, which play an important role in regulating the immune system and fighting viral infections, and in B lymphocytes, which produce antibodies essential to fighting some infections.

 

Hodgkin's lymphoma is a type of lymphoma that is believed to have originated from B lymphocytes.

 

In Korea, it accounts for about 5% of all lymphoma.

 

Hodgkin's lymphoma has a high cure rate.

 

In the case of local weapons, more than 95% of them are completely cured.

 

However, about half of the high-risk groups of advanced stage patients suffer recurrence.

 

Overall, it shows a recurrence rate of more than 20%.

 

Patients who recur or fail to comply with treatment with cocktail therapy represented by ABVD consider autologous hematopoietic stem cell transplantation.

 

The cure rate during transplantation is reported to be about 50%.

 

However, the treatment of patients who cannot be transplanted or recur after transplantation still remains a homework.

 

Professor Yoon said, "Self-hematopoietic stem cell transplantation is like high-dose chemotherapy, so patients who do not respond to chemotherapy cannot try it.

 

This is one in three.

 

In addition, about 20% of all patients are elderly or in poor systemic condition, so they cannot withstand transplants.

 

The homework was how to treat these patients and those who recur after transplantation.

 

Adcetris is the drug that contributed to improving their survival rate.

 

It was a drug that combined strong anticancer drugs with antibodies targeting cancer, and it was effective not only in recurrent patients, but also in post-transplantation maintenance therapy and first-line treatment in high-risk groups." Although Adcetris has become the most effective drug for treating recurrence patients, many patients still experience recurrence with a 5-year progression-free survival rate of 20%, Professor Yoon said.

 

At this time, Keytruda emerged as a new option by expanding the indication to Hodgkin's lymphoma.

 

In particular, Keytruda first demonstrated superiority through a direct head-to-head comparison with Adcetris in phase 3 KEYNOTE-204.

 

In this clinical trial, the risk of disease progression and death in the Keytruda group was 35% lower than that of the Adcetris group, and the median duration of progression-free survival was 13.2 months, showing a significant improvement compared to the control group (8.3 months).

 

The objective reaction rate of the Keytruda group was 65.6%, and one in four showed complete remission.

 

The median value and quality of life of the reaction duration were also significantly improved compared to the Adcetris group.

 

Professor Yoon said, "When I used Keytruda at the treatment site, the quality of life of the patient increased due to its resistance, and it was convenient for patients as they only had to come once every three weeks without hospitalization.

 

There was little hematological toxicity, he said.

 

"Keytruda recorded a progression-free survival rate of 30-40% at the time of three years, which was higher than any other treatment." Since March, Keytruda benefits have been applied to Hodgkin's lymphoma, and treatment patterns at the treatment site have also changed.

 

Professor Yoon said, "Based on the comparative clinical results, Keytruda can be considered first in almost all patients.

 

If it is not an exceptional case, such as accompanying autoimmune diseases, we will use Keytruda first, he said.

 

"Keytruda can be an important breakthrough in recurrent patients." Of course, Keytruda is not the perfect solution.

 

Due to clinical design, Keytruda treatment is difficult to exceed two years.

 

The reaction rate is high, but the rate of complete remission is 25%, which is also limited to achieving the goal of "complete recovery." However, Professor Yoon highly predicted the possibility of immuno-cancer drugs in Hodgkin's lymphoma, given that various clinical trials are underway beyond the effects of existing treatments.

 

He said, "It is clear that immuno-cancer drugs will play a more role in the future as several clinical trials are currently underway in Hodgkin's lymphoma, including post-transplantation maintenance therapy and primary treatment therapy, including Keytruda."