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HL is a malignant proliferative tumor of the lymphatic system, and its incidence accounts for about 10% of all lymphomas, including classic Hodgkin’s lymphoma (cHL) and nodular lymphocyte-based Hodgkin’s lymphoma (NLPHL) ).
Among them, cHL is divided into nodular sclerosis type cHL (NSHL), mixed cell type cHL (MCHL), lymphocyte-rich cHL (LRCHL) and lymphocyte depletion type cHL (LDHL), accounting for about 95% of HL.
In East Asian countries, including my country, cHL is more common among young and middle-aged people.
The age of onset is mostly 30-40 years old, and there are more men than women.
In recent decades, the treatment of HL patients has made significant progress, but there are still a small number of HL patients who are refractory or relapsed, which has also become a difficulty and challenge in clinical treatment.
At the "2021 Jinling Lymphoma Forum" meeting held in Nanjing, Jiangsu Province on May 14-16, 2021, Professor Wang Huaqing from Tianjin People's Hospital shared the standardized treatment of Hodgkin's lymphoma (HL) and the progress of new drugs .
Yimaitong organizes the main content as follows for the reference of readers.
The treatment of R/R HL urgently needs a breakthrough.
According to the Ann Arbor staging and the presence or absence of risk factors, HL can be divided into good early prognosis, poor early prognosis and late (Figure 1).
This shows that HL requires stratified treatment.
The overall treatment of HL in North America and Germany is slightly different.
Doctors in North America prefer ABVD (adriamycin, bleomycin, vincristine and dacarbazine) regimens and radiotherapy; and the German Hodgkin Lymphoma Study The group mostly used ABVD or BEACOPP (Figure 2).Figure 1 Figure 2 Professor Wang said that HL is a curable disease.
The initial treatment cure rate is high.
The overall 5-year overall survival (OS) rate is 87%.
However, about 10% of the early stage and about 30% of the advanced stage HL patients develop refractory or relapse after treatment with the first-line ABVD regimen and require further treatment, which has also become a difficulty and challenge in clinical treatment.
In addition, the general clinical characteristics of HL patients in my country are similar to those of Western patients, but the treatment results are slightly worse.
The treatment results of 150 HL patients in 4 centers in my country from 2000 to 2014 showed that the complete remission (CR) rate was 73%, while data published in Western countries in 2010 showed that the CR rate of early HL patients was 96%, and that of advanced HL The CR rate of the patients was 76%.
High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDT/ASCT) is the standard treatment after failure of first-line treatment for HL, but its 5-year OS rate is only about 50%.
Therefore, the treatment of relapsed/refractory (R/R) HL urgently needs a breakthrough.
Verbutuximab-a new hope for CD30-positive HL patients.
The RS cells of HL express CD30 uniformly on the surface.
Since CD30 is rarely expressed on the surface of normal cells, it can become a potential therapeutic target for HL.
As a result, the ADC drug brentuximab vedotin (BV), which targets CD30, came into being, which can efficiently kill CD30+ tumor cells and activate the immune system, by inducing immunogenic cell death, and triggering anti-tumor immune response.
Professor Wang said that achieving CR before ASCT is an important condition for the successful transplantation of R/R HL patients, and the CR rate of traditional salvage chemotherapy is relatively low.
Studies have shown that for patients with R/R HL suitable for transplantation, BV combined/sequential chemotherapy (such as BV+ESHAP, BV+ICE, BV+DHAP) can optimize the chance of cure after HDT/ASCT and improve remission.
However, elderly HL patients generally cannot tolerate combined chemotherapy and transplantation, and often need to adjust the dose, the treatment toxicity risk is greater, and the prognosis is significantly worse.
The results of the first real-world retrospective study of BV in patients who are not suitable for transplantation showed that after a median follow-up of 10.
9 months in 136 elderly patients, the median progression-free survival (PFS) was 15.
1 months and the median OS was 17.
8 Month, the 12-month PFS rate was 52.
1%, and the 12-month OS rate was 68.
2%.
Professor Wang said that BV alone can improve the efficacy and prognosis.
It is a treatment option for elderly HL patients who are not suitable for transplantation.
What about the long-term follow-up data of BV? In the long-term follow-up of a real-world study, 58 patients with R/R HL in 11 centers received BV treatment, and after a median follow-up of 20 months, the 5-year PFS rate of CR patients was 32%, and the 5-year OS rate Is 60%.
Professor Wang said that BV can enable a considerable number of R/R HL patients to achieve long-term and safe benefits, and the clinical application prospects are very exciting.
PD-1 inhibitors for the treatment of cHL can be expected in the future.
The treatment of cHL has experienced traditional cytotoxic drugs, targeted therapy, and the rise of immunotherapy.
Now cHL has entered the age of immunotherapy.
So what is the efficacy of immunotherapy for cHL? In the Phase 2 study of CheckMate 205, 51 patients with newly-treated and late-stage cHL were enrolled.
Nivolumab (Nivolumab) + doxorubicin + vinblastine + dacarbazine (N-AVD) sequential combination The overall response rate (ORR) of the program can reach 84%, and the CR rate is 67%.
The 9-month PFS rate is 92%; and the sequential combination program is well tolerated, no pulmonary toxicity occurs, and 90% of the patients completed the combination Treatment, no significant immune-related adverse reactions.
It can be seen that the sequential N-AVD regimen of nivolumab has promising efficacy and safety in newly diagnosed patients with advanced cHL, and it is a promising and well-tolerated treatment option.
In addition, the Phase 2 study of NU1608 evaluated the efficacy and safety of pembrolizumab sequential AVD (P-AVD) regimen in the first-line treatment of 30 patients with early poor prognosis and advanced cHL.
The results showed that the CR rate was 100%, and no patients discontinued treatment due to adverse events, and no incidents of pneumonia or colitis occurred, and the safety was good.
It is worth noting that the single-center, open-ended, two-arm phase 2 study conducted by Professor Han Weidong of the Chinese People’s Liberation Army General Hospital explored the treatment of R/R HL patients with low-dose decitabine and camrelizumab The results show that patients with ≥3 line therapy can tolerate and have significant anti-tumor activity.
The above studies have demonstrated the excellent efficacy and safety of PD-1 monoclonal antibody in cHL.
In addition, the study of BV+nivolumab+AD (adriamycin+dacarbazine) in the treatment of newly diagnosed advanced HL patients is underway.
Professor Wang said that he expects a higher remission rate and Less toxic.
Professor Wang Huaqing, Doctor of Medicine, Chief Physician, Doctoral Supervisor, Deputy Dean of Tianjin People's Hospital of Nankai University, Director of Tumor Diagnosis and Treatment Center, Director of National Drug Clinical Trial Institute, Director of Tianjin Integrated Traditional Chinese and Western Medicine Tumor Research Institute, Chinese Anti-Cancer Association Lymphoma Professional Committee Former Chairman, National Council of China Anti-Cancer Association, Chinese Society of Clinical Oncology (CSCO), Executive Director, Chinese Society of Anti-Cancer Association, Vice-Chairman of Clinical Chemotherapy Committee, Chinese Anti-Cancer Association Executive member of the Oncology Committee Chairman of the Oncology Committee of the Tianjin Integrative Medicine Association Vice Chairman of the Oncology Precision Therapy Committee of the Tianjin Anti-Cancer Association Deputy Chairman of the Hematological Oncology Committee of the Tianjin Anti-Cancer Association Vice Chairman of the Oncology Committee of the Tianjin Medical Association Standing Committee Member of the Hematology Committee of Tianjin Medical Association, National Food and Drug Administration New Drug Review Expert stamp "Read the original", we will make progress together
Among them, cHL is divided into nodular sclerosis type cHL (NSHL), mixed cell type cHL (MCHL), lymphocyte-rich cHL (LRCHL) and lymphocyte depletion type cHL (LDHL), accounting for about 95% of HL.
In East Asian countries, including my country, cHL is more common among young and middle-aged people.
The age of onset is mostly 30-40 years old, and there are more men than women.
In recent decades, the treatment of HL patients has made significant progress, but there are still a small number of HL patients who are refractory or relapsed, which has also become a difficulty and challenge in clinical treatment.
At the "2021 Jinling Lymphoma Forum" meeting held in Nanjing, Jiangsu Province on May 14-16, 2021, Professor Wang Huaqing from Tianjin People's Hospital shared the standardized treatment of Hodgkin's lymphoma (HL) and the progress of new drugs .
Yimaitong organizes the main content as follows for the reference of readers.
The treatment of R/R HL urgently needs a breakthrough.
According to the Ann Arbor staging and the presence or absence of risk factors, HL can be divided into good early prognosis, poor early prognosis and late (Figure 1).
This shows that HL requires stratified treatment.
The overall treatment of HL in North America and Germany is slightly different.
Doctors in North America prefer ABVD (adriamycin, bleomycin, vincristine and dacarbazine) regimens and radiotherapy; and the German Hodgkin Lymphoma Study The group mostly used ABVD or BEACOPP (Figure 2).Figure 1 Figure 2 Professor Wang said that HL is a curable disease.
The initial treatment cure rate is high.
The overall 5-year overall survival (OS) rate is 87%.
However, about 10% of the early stage and about 30% of the advanced stage HL patients develop refractory or relapse after treatment with the first-line ABVD regimen and require further treatment, which has also become a difficulty and challenge in clinical treatment.
In addition, the general clinical characteristics of HL patients in my country are similar to those of Western patients, but the treatment results are slightly worse.
The treatment results of 150 HL patients in 4 centers in my country from 2000 to 2014 showed that the complete remission (CR) rate was 73%, while data published in Western countries in 2010 showed that the CR rate of early HL patients was 96%, and that of advanced HL The CR rate of the patients was 76%.
High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDT/ASCT) is the standard treatment after failure of first-line treatment for HL, but its 5-year OS rate is only about 50%.
Therefore, the treatment of relapsed/refractory (R/R) HL urgently needs a breakthrough.
Verbutuximab-a new hope for CD30-positive HL patients.
The RS cells of HL express CD30 uniformly on the surface.
Since CD30 is rarely expressed on the surface of normal cells, it can become a potential therapeutic target for HL.
As a result, the ADC drug brentuximab vedotin (BV), which targets CD30, came into being, which can efficiently kill CD30+ tumor cells and activate the immune system, by inducing immunogenic cell death, and triggering anti-tumor immune response.
Professor Wang said that achieving CR before ASCT is an important condition for the successful transplantation of R/R HL patients, and the CR rate of traditional salvage chemotherapy is relatively low.
Studies have shown that for patients with R/R HL suitable for transplantation, BV combined/sequential chemotherapy (such as BV+ESHAP, BV+ICE, BV+DHAP) can optimize the chance of cure after HDT/ASCT and improve remission.
However, elderly HL patients generally cannot tolerate combined chemotherapy and transplantation, and often need to adjust the dose, the treatment toxicity risk is greater, and the prognosis is significantly worse.
The results of the first real-world retrospective study of BV in patients who are not suitable for transplantation showed that after a median follow-up of 10.
9 months in 136 elderly patients, the median progression-free survival (PFS) was 15.
1 months and the median OS was 17.
8 Month, the 12-month PFS rate was 52.
1%, and the 12-month OS rate was 68.
2%.
Professor Wang said that BV alone can improve the efficacy and prognosis.
It is a treatment option for elderly HL patients who are not suitable for transplantation.
What about the long-term follow-up data of BV? In the long-term follow-up of a real-world study, 58 patients with R/R HL in 11 centers received BV treatment, and after a median follow-up of 20 months, the 5-year PFS rate of CR patients was 32%, and the 5-year OS rate Is 60%.
Professor Wang said that BV can enable a considerable number of R/R HL patients to achieve long-term and safe benefits, and the clinical application prospects are very exciting.
PD-1 inhibitors for the treatment of cHL can be expected in the future.
The treatment of cHL has experienced traditional cytotoxic drugs, targeted therapy, and the rise of immunotherapy.
Now cHL has entered the age of immunotherapy.
So what is the efficacy of immunotherapy for cHL? In the Phase 2 study of CheckMate 205, 51 patients with newly-treated and late-stage cHL were enrolled.
Nivolumab (Nivolumab) + doxorubicin + vinblastine + dacarbazine (N-AVD) sequential combination The overall response rate (ORR) of the program can reach 84%, and the CR rate is 67%.
The 9-month PFS rate is 92%; and the sequential combination program is well tolerated, no pulmonary toxicity occurs, and 90% of the patients completed the combination Treatment, no significant immune-related adverse reactions.
It can be seen that the sequential N-AVD regimen of nivolumab has promising efficacy and safety in newly diagnosed patients with advanced cHL, and it is a promising and well-tolerated treatment option.
In addition, the Phase 2 study of NU1608 evaluated the efficacy and safety of pembrolizumab sequential AVD (P-AVD) regimen in the first-line treatment of 30 patients with early poor prognosis and advanced cHL.
The results showed that the CR rate was 100%, and no patients discontinued treatment due to adverse events, and no incidents of pneumonia or colitis occurred, and the safety was good.
It is worth noting that the single-center, open-ended, two-arm phase 2 study conducted by Professor Han Weidong of the Chinese People’s Liberation Army General Hospital explored the treatment of R/R HL patients with low-dose decitabine and camrelizumab The results show that patients with ≥3 line therapy can tolerate and have significant anti-tumor activity.
The above studies have demonstrated the excellent efficacy and safety of PD-1 monoclonal antibody in cHL.
In addition, the study of BV+nivolumab+AD (adriamycin+dacarbazine) in the treatment of newly diagnosed advanced HL patients is underway.
Professor Wang said that he expects a higher remission rate and Less toxic.
Professor Wang Huaqing, Doctor of Medicine, Chief Physician, Doctoral Supervisor, Deputy Dean of Tianjin People's Hospital of Nankai University, Director of Tumor Diagnosis and Treatment Center, Director of National Drug Clinical Trial Institute, Director of Tianjin Integrated Traditional Chinese and Western Medicine Tumor Research Institute, Chinese Anti-Cancer Association Lymphoma Professional Committee Former Chairman, National Council of China Anti-Cancer Association, Chinese Society of Clinical Oncology (CSCO), Executive Director, Chinese Society of Anti-Cancer Association, Vice-Chairman of Clinical Chemotherapy Committee, Chinese Anti-Cancer Association Executive member of the Oncology Committee Chairman of the Oncology Committee of the Tianjin Integrative Medicine Association Vice Chairman of the Oncology Precision Therapy Committee of the Tianjin Anti-Cancer Association Deputy Chairman of the Hematological Oncology Committee of the Tianjin Anti-Cancer Association Vice Chairman of the Oncology Committee of the Tianjin Medical Association Standing Committee Member of the Hematology Committee of Tianjin Medical Association, National Food and Drug Administration New Drug Review Expert stamp "Read the original", we will make progress together
