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Hodgkin disease: two drugs that are not beneficial to patients

In the absence of any proven increase in life expectancy, there is no justification for exposing patients with Hodgkin disease to the many, sometimes severe, adverse effects of nivolumab (Opdivo°) and brentuximab vedotin (Adcetris°).

In patients with Hodgkin disease (a form of lymphoma), the choice of treatment depends on the stage of the disease. High-dose chemotherapy followed by a stem cell transplant using the patient’s own healthy cells is offered to some patients when the lymphoma is refractory or relapsed.

Nivolumab, an immunostimulant antibody, is approved in patients who have relapsed or refractory lymphoma and who have already received an autologous stem cell transplant and brentuximab vedotin, a cytotoxic agent combined with a monoclonal antibody. In this situation, there is no evidence of prolonged life expectancy with nivolumab, whereas its adverse effects are many and sometimes severe or even fatal. Taking nivolumab also compromises the use of donor stem cell transplants because of an increased risk of graft-versus-host disease.

Brentuximab vedotin received EU authorisation in 2012 for adults with relapsing Hodgkin disease, despite its uncertain harm-benefit balance, and with no evidence that it prolongs life expectancy. In 2016, brentuximab vedotin was also approved as a treatment immediately after autologous stem cell transplant in Hodgkin disease patients at high risk of relapse. In this situation, the results of the clinical trial show no increased life expectancy compared with monitoring without treatment. At present, it is not justified to expose patients in remission to brentuximab vedotin, which carries many, sometimes fatal, adverse effects.

©Prescrire 1 March 2018

"Nivolumab (Opdivo°) and Hodgkin lymphoma. Barely evaluated" Prescrire Int 2018; 27 (191): 63-65. (Pdf, subscribers only).

"Brentuximab vedotin (Adcetris°) in Hodgkin lymphoma, immediately after autologous transplantation" Prescrire Int 2018; 27 (191): 65. (Pdf, subscribers only).

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Download the full reviews:

Nivolumab (Opdivo°)
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Brentuxumab vedotin
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