Strategies for Recognizing and Managing Immune-Mediated Adverse Events in the Treatment of Hodgkin Lymphoma with Checkpoint Inhibitors

Vardhana, Santosha A.; Cicero, Kara; Velez, Moises J.; Moskowitz, Craig H.

doi:10.1634/theoncologist.2018-0045

Cited by 10 publications

(7 citation statements)

References 38 publications

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“…Clinical symptoms are not always an accurate measure of disease severity. [6][7][8][9] High-risk endoscopic features (presence of large, deep, and multiple ulcers and extensive inflammation) are associated with an increased risk of recurrence after clinical remission, frequent use of selective immunosuppressive therapy (SIT; ie, infliximab or vedolizumab), higher rates of hospitalization, and longer hospital stays. 6 We demonstrated that fecal calprotectin (FC) as a stool inflammatory marker in patients with IMDC had a strong association with endoscopic severity.…”

Section: Introductionmentioning

confidence: 99%

Fecal calprotectin concentration to assess endoscopic and histologic remission in patients with cancer with immune-mediated diarrhea and colitis

Zou

Wang

Glitza

et al. 2021

J Immunother Cancer

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BackgroundImmune-mediated diarrhea and colitis (IMDC) is currently diagnosed and monitored by evaluating clinical symptoms. Deep remission is determined by endoscopic and histologic evaluation of the disease process. However, repeating these invasive procedures frequently can become cumbersome. We sought to assess the role of fecal calprotectin (FC) concentration as a non-invasive biomarker of endoscopic or histologic remission.MethodsWe performed a retrospective study of patients with IMDC who were tested for FC at IMDC onset and after IMDC treatment between June 2016 and March 2020. Patient demographics, clinical variables, and FC data were collected and analyzed to determine the optimal cut-off FC concentration to predict endoscopic and histologic remission.ResultsOur sample comprised 77 patients with a median age of 62 years; 66% were male and 94% were Caucasian. Sixty-five patients (84%) achieved clinical remission, 46 (60%) achieved endoscopic remission, and 24 (31%) achieved histologic remission after IMDC treatment. FC concentrations decreased from the time of IMDC onset to the end of treatment (p<0.001). High FC concentrations were associated with evident endoscopic inflammation (p=0.003) and acute/chronic active colitis (p=0.025) which positively correlated with the Mayo Endoscopic Subscore (r=0.615, p=0.001) at the time of IMDC onset. In patients who achieved endoscopic remission after treatment, a significantly lower FC concentration was observed at IMDC onset (p=0.006) and after treatment (p<0.001) compared with those without endoscopic remission. The cut-off FC concentration to predict endoscopic remission was ≤116 μg/g and for histologic remission ≤80 μg/g; these cut-offs had optimal specificity (94% and 85%, respectively) and positive predictive value (0.91 and 0.38, respectively).ConclusionsFC concentration may serve as a non-invasive biomarker to predict endoscopic and histologic remission in patients receiving treatment for IMDC, minimizing the need for frequent invasive endoscopies. Future prospective studies are needed to provide further insight on the role of this marker in disease surveillance.

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Section: Introductionmentioning

confidence: 99%

Fecal calprotectin concentration to assess endoscopic and histologic remission in patients with cancer with immune-mediated diarrhea and colitis

Zou

Wang

Glitza

et al. 2021

J Immunother Cancer

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“…Je nach Ausprägung der Autoimmunreaktion kann z. B. die Gabe von Kortikosteroiden oder ein Pausieren der Medikation erwogen werden [363].…”

Section: Impfen Bei Therapie Mit Checkpoint-inhibitorenunclassified

Impfen bei Immundefizienz

Laws

Baumann

Bogdan

et al. 2020

Bundesgesundheitsbl

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“…Toxicities of checkpoint inhibitors. 185,186 In addition, pseudoprogression, an immunemediated tumor flare, may be observed early during checkpoint inhibitor therapy, and may provoke treatment discontinuation. For this purpose, modified criteria of response have been developed in order to account for this and avoid inappropriate premature drug discontinuation, as discussed above.…”

Section: Brentuximab Vedotin As Salvage Therapy For Relapsed/refractomentioning

confidence: 99%

“…The median time to occurrence of IMAEs is ~12 weeks (range between 1 and 112 weeks). Specific guidelines for the management of the IMAEs associated with checkpoint inhibitors have been published elsewhere 185,186…”

Section: Third-line Therapy and Beyondmentioning

confidence: 99%

Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies

Vassilakopoulos

Asimakopoulos

Konstantopoulos

et al. 2020

Therapeutic Advances in Hematology

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The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.

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Strategies for Recognizing and Managing Immune-Mediated Adverse Events in the Treatment of Hodgkin Lymphoma with Checkpoint Inhibitors

Cited by 10 publications

References 38 publications

Fecal calprotectin concentration to assess endoscopic and histologic remission in patients with cancer with immune-mediated diarrhea and colitis

Fecal calprotectin concentration to assess endoscopic and histologic remission in patients with cancer with immune-mediated diarrhea and colitis

Impfen bei Immundefizienz

Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies

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