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Lymphocytic disease is currently one of the most vigorous fields in hematology at home and abroad.
In recent years, remarkable achievements have been made in the pathogenesis of the disease to targeted and immunotherapy.
In order to promote domestic and international peer exchanges, the First National Lymphocytic Disease Academic Conference of the Chinese Medical Association and the 2021 International Lymphoma Update Symposium will be held on April 16-18, 2021.
The conference specially invited well-known experts at home and abroad to give wonderful speeches, covering many aspects of lymphocytic diseases.
Yimaitong was fortunate to invite Professor Wang Luqun from Qilu Hospital of Shandong University to share the current status and research progress of classic Hodgkin's lymphoma at this conference.
Professor Wang Luqun, Chief Physician, Doctor of Medicine, Shandong University Professor of Internal Medicine, Shandong University Qilu Hospital Chief Physician, Member of the Asian Myeloma Network (AMN) Member of the Plasma Cell Disease Group of the Hematology Branch of the Chinese Medical Association Multiple Myeloma Member of the Professional Committee Member of the Myeloma and Plasma Cell Disease Group of the Hematological Oncology Committee of the Chinese Anti-Cancer Society Member of the Anti-Lymphoma Alliance of the Chinese Society of Clinical Oncology Member of the Standing Committee of the Hematology Specialty Committee of the Chinese Society of Medical Education Member of the Standing Committee of the Hematology Expert Committee of the Chinese Society of Geriatrics Member of the Hematology Committee Member of the Hematology Committee of Shandong Medical Association Member of the Hematology Committee of Shandong Anticancer Association Member of the Shandong Multiple Myeloma Working Group Leader of the Shandong Provincial Multiple Myeloma Working Group to be engaged in the clinical diagnosis and treatment of lymphocytic and plasma cell diseases and basic research, good at lymph Comprehensive diagnosis and treatment of tumors and myeloma.
He has rich clinical experience in the diagnosis and treatment of refractory, relapsed lymphoma and multiple myeloma.
Presided over and participated in more than 10 national, provincial and ministerial-level scientific research projects, and successively won 13 provincial and ministerial-level scientific and technological achievements awards.
Yimaitong: First of all, could you please introduce the current status of the treatment of classic Hodgkin's lymphoma (cHL)? What are the unmet treatment needs of cHL patients, especially those with relapsed and refractory cHL? Professor Wang Luqun's current traditional chemotherapy regimens such as ABVD and AVD have achieved good results in 75%-80% of cHL patients, with an overall response rate (ORR) of more than 90%.
However, there are still 15%-20% of cHL patients who cannot achieve better curative effects through current chemotherapy regimens, or cannot tolerate the side effects of current chemotherapy regimens.
How to improve the prognosis of these cHL patients with poor efficacy of traditional chemotherapy is a difficult problem that needs to be solved in clinical practice of cHL.
Yimaitong: Targeted and immunotherapy have made great progress in relapsed and refractory cHL in recent years.
Could you please review and summarize the breakthroughs made in relapsed and refractory cHL in recent years? Because the current traditional chemotherapy regimens still cannot fully meet the clinical needs of cHL, Professor Luqun Wang has explored the application of new targeted drugs in cHL in recent years.
The representative drug is PD-1/PD-L1 antibody.
These new targeted drugs have clinically improved the efficacy of cHL patients who cannot tolerate traditional chemotherapy regimens, are resistant to traditional chemotherapy regimens, and relapse after treatment, with ORR even as high as 80%.
However, PD-1/PD-L1 monoclonal antibody still has certain shortcomings in cHL.
Firstly, the complete remission (CR) rate of PD-1/PD-L1 monoclonal antibody in cHL patients is not high, only 20%-30%.
PD-1/PD-L1 monoclonal antibody may bring better short-term efficacy to cHL patients, but whether it can bring long-term survival to cHL patients remains to be further confirmed by follow-up studies.
Secondly, the long-term immune-related toxicity caused by PD-1/PD-L1 monoclonal antibody treatment is also a clinical problem that needs to be solved.
Some cHL patients will have complications after receiving PD-1/PD-L1 monoclonal antibody treatment.
In addition, some cHL patients are not suitable for PD-1/PD-L1 monoclonal antibody.
CD30 is an important biomarker of HL.
It is strongly expressed on the surface of HL's iconic Reed-Sternberg cells and has limited expression on the surface of normal cells, making it a good therapeutic target for HL.
Therefore, in addition to the PD-1/PD-L1 monoclonal antibody, the CD30-targeted monoclonal antibody vebutuximab is also a drug worthy of attention in the treatment of cHL.
Verbutuximab is coupled with an anti-tubulin drug, which enters the lysosome to release toxins after being endocytosed by cells, which enhances the killing effect of bystanders and obtains a better curative effect.
The phase III ECHELON-1 study compared the efficacy of verbutuximab combined with AVD regimen and ABVD regimen in patients with stage III/IV cHL.
The results of the study showed that the verbutuximab combined with AVD regimen showed good efficacy regardless of the patient’s age, mid-treatment PET-CT assessment results, staging, and IPS score, reducing the risk of disease progression by 30%, and at the same time Security is controllable.
At present, vebutuximab has been approved in the United States and the European Union for the combined AVD regimen for the treatment of late-stage adult cHL patients.
In addition, the traditional chemotherapy regimens of verbutuximab and cHL and PD-1/PD-L1 monoclonal antibody have no clear cross-resistance, and the efficacy of traditional chemotherapy and even PD-1/PD-L1 monoclonal antibody is not good.
Patients with cHL are better treatment options.
Vibutuximab also has the advantages of small side effects and good tolerance.
It is also a better treatment option for elderly cHL patients who are not suitable for traditional chemotherapy and are in poor health.
Yimaitong: What are your prospects for the future treatment of relapsed and refractory cHL? In your opinion, what other research directions are worth exploring for cHL in the future? Although Professor Wang Luqun currently has traditional chemotherapy and targeted therapy in patients with relapsed and refractory cHL, and even some patients with relapsed and refractory cHL have long-term survival, there are still about 10% of patients with primary drug resistance.
After multi-line treatment, the long-term survival needs cannot be met. Antibody targeted drugs and non-antibody small molecule targeted drugs combined with traditional chemotherapy may be a direction worth exploring in the future of cHL treatment.
The combination of cellular immunotherapy and antibodies can bring survival benefits to patients with relapsed and refractory cHL.
In addition, hematopoietic stem cell transplantation may also bring survival benefits to patients with relapsed and refractory cHL.
In the future, comprehensive treatment may be the direction for the development of relapsed and refractory cHL.
Poke "read the original text" and we will make progress together
In recent years, remarkable achievements have been made in the pathogenesis of the disease to targeted and immunotherapy.
In order to promote domestic and international peer exchanges, the First National Lymphocytic Disease Academic Conference of the Chinese Medical Association and the 2021 International Lymphoma Update Symposium will be held on April 16-18, 2021.
The conference specially invited well-known experts at home and abroad to give wonderful speeches, covering many aspects of lymphocytic diseases.
Yimaitong was fortunate to invite Professor Wang Luqun from Qilu Hospital of Shandong University to share the current status and research progress of classic Hodgkin's lymphoma at this conference.
Professor Wang Luqun, Chief Physician, Doctor of Medicine, Shandong University Professor of Internal Medicine, Shandong University Qilu Hospital Chief Physician, Member of the Asian Myeloma Network (AMN) Member of the Plasma Cell Disease Group of the Hematology Branch of the Chinese Medical Association Multiple Myeloma Member of the Professional Committee Member of the Myeloma and Plasma Cell Disease Group of the Hematological Oncology Committee of the Chinese Anti-Cancer Society Member of the Anti-Lymphoma Alliance of the Chinese Society of Clinical Oncology Member of the Standing Committee of the Hematology Specialty Committee of the Chinese Society of Medical Education Member of the Standing Committee of the Hematology Expert Committee of the Chinese Society of Geriatrics Member of the Hematology Committee Member of the Hematology Committee of Shandong Medical Association Member of the Hematology Committee of Shandong Anticancer Association Member of the Shandong Multiple Myeloma Working Group Leader of the Shandong Provincial Multiple Myeloma Working Group to be engaged in the clinical diagnosis and treatment of lymphocytic and plasma cell diseases and basic research, good at lymph Comprehensive diagnosis and treatment of tumors and myeloma.
He has rich clinical experience in the diagnosis and treatment of refractory, relapsed lymphoma and multiple myeloma.
Presided over and participated in more than 10 national, provincial and ministerial-level scientific research projects, and successively won 13 provincial and ministerial-level scientific and technological achievements awards.
Yimaitong: First of all, could you please introduce the current status of the treatment of classic Hodgkin's lymphoma (cHL)? What are the unmet treatment needs of cHL patients, especially those with relapsed and refractory cHL? Professor Wang Luqun's current traditional chemotherapy regimens such as ABVD and AVD have achieved good results in 75%-80% of cHL patients, with an overall response rate (ORR) of more than 90%.
However, there are still 15%-20% of cHL patients who cannot achieve better curative effects through current chemotherapy regimens, or cannot tolerate the side effects of current chemotherapy regimens.
How to improve the prognosis of these cHL patients with poor efficacy of traditional chemotherapy is a difficult problem that needs to be solved in clinical practice of cHL.
Yimaitong: Targeted and immunotherapy have made great progress in relapsed and refractory cHL in recent years.
Could you please review and summarize the breakthroughs made in relapsed and refractory cHL in recent years? Because the current traditional chemotherapy regimens still cannot fully meet the clinical needs of cHL, Professor Luqun Wang has explored the application of new targeted drugs in cHL in recent years.
The representative drug is PD-1/PD-L1 antibody.
These new targeted drugs have clinically improved the efficacy of cHL patients who cannot tolerate traditional chemotherapy regimens, are resistant to traditional chemotherapy regimens, and relapse after treatment, with ORR even as high as 80%.
However, PD-1/PD-L1 monoclonal antibody still has certain shortcomings in cHL.
Firstly, the complete remission (CR) rate of PD-1/PD-L1 monoclonal antibody in cHL patients is not high, only 20%-30%.
PD-1/PD-L1 monoclonal antibody may bring better short-term efficacy to cHL patients, but whether it can bring long-term survival to cHL patients remains to be further confirmed by follow-up studies.
Secondly, the long-term immune-related toxicity caused by PD-1/PD-L1 monoclonal antibody treatment is also a clinical problem that needs to be solved.
Some cHL patients will have complications after receiving PD-1/PD-L1 monoclonal antibody treatment.
In addition, some cHL patients are not suitable for PD-1/PD-L1 monoclonal antibody.
CD30 is an important biomarker of HL.
It is strongly expressed on the surface of HL's iconic Reed-Sternberg cells and has limited expression on the surface of normal cells, making it a good therapeutic target for HL.
Therefore, in addition to the PD-1/PD-L1 monoclonal antibody, the CD30-targeted monoclonal antibody vebutuximab is also a drug worthy of attention in the treatment of cHL.
Verbutuximab is coupled with an anti-tubulin drug, which enters the lysosome to release toxins after being endocytosed by cells, which enhances the killing effect of bystanders and obtains a better curative effect.
The phase III ECHELON-1 study compared the efficacy of verbutuximab combined with AVD regimen and ABVD regimen in patients with stage III/IV cHL.
The results of the study showed that the verbutuximab combined with AVD regimen showed good efficacy regardless of the patient’s age, mid-treatment PET-CT assessment results, staging, and IPS score, reducing the risk of disease progression by 30%, and at the same time Security is controllable.
At present, vebutuximab has been approved in the United States and the European Union for the combined AVD regimen for the treatment of late-stage adult cHL patients.
In addition, the traditional chemotherapy regimens of verbutuximab and cHL and PD-1/PD-L1 monoclonal antibody have no clear cross-resistance, and the efficacy of traditional chemotherapy and even PD-1/PD-L1 monoclonal antibody is not good.
Patients with cHL are better treatment options.
Vibutuximab also has the advantages of small side effects and good tolerance.
It is also a better treatment option for elderly cHL patients who are not suitable for traditional chemotherapy and are in poor health.
Yimaitong: What are your prospects for the future treatment of relapsed and refractory cHL? In your opinion, what other research directions are worth exploring for cHL in the future? Although Professor Wang Luqun currently has traditional chemotherapy and targeted therapy in patients with relapsed and refractory cHL, and even some patients with relapsed and refractory cHL have long-term survival, there are still about 10% of patients with primary drug resistance.
After multi-line treatment, the long-term survival needs cannot be met. Antibody targeted drugs and non-antibody small molecule targeted drugs combined with traditional chemotherapy may be a direction worth exploring in the future of cHL treatment.
The combination of cellular immunotherapy and antibodies can bring survival benefits to patients with relapsed and refractory cHL.
In addition, hematopoietic stem cell transplantation may also bring survival benefits to patients with relapsed and refractory cHL.
In the future, comprehensive treatment may be the direction for the development of relapsed and refractory cHL.
Poke "read the original text" and we will make progress together
