Safety and Efficacy in Relapsed or Refractory Classic Hodgkin’s Lymphoma Treated with PD-1 Inhibitors: A Meta-Analysis of 9 Prospective Clinical Trials

Abstract

Background. Classic Hodgkin’s lymphoma (cHL) is characterized by the unique biology in which rare Hodgkin-Reed-Sternberg cells propagate an immunosuppressive microenvironment. Checkpoint inhibitors that target the interaction of PD-1 immune checkpoint receptors have demonstrated remarkable activities in various cancers, such as cHL. This study aims to evaluate the safety and efficacy of PD-1 inhibitors in treating relapsed or refractory cHL (rrHL). Methods. We searched PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang, Chinese Biological Medical Literature, and Abstracts of Conference proceedings of annual meetings without any language restrictions to limit language bias (up to January 2019) for prospective clinical trials that evaluate PD-1 inhibitors in treating relapsed or refractory cHL. Results. A total of 9 prospective clinical trials with 731 patients were included in the meta-analysis. The pooled risks of all-grade and grade ≥3 adverse events (AEs) were 0.86 (95% CI: 0.66–0.98) and 0.21 (95% CI: 0.17–0.24), respectively. The pooled response, complete response, partial response, and stable disease rates were 0.74 (95% CI: 0.70–0.79), 0.24 (95% CI: 0.18–0.34), 0.48 (95% CI: 0.41–0.55), and 0.15 (95% CI: 0.12–0.17), respectively. The pooled 6-month progression-free survival and 1-year overall survival rates were 0.76 (95% CI: 0.72–0.79) and 0.93 (95% CI: 0.90–0.96), correspondingly. Conclusions. Our meta-analysis suggested that anti-PD1 monoclonal antibodies improve the outcomes of response and survival rates with tolerable AEs in cHL. However, evidence of immune checkpoint inhibitors for patients with cHL remained insufficient. Well-designed randomized controlled trials or at least nonrandomized trials with a control group should be conducted to confirm the findings of this meta-analysis.

Attitudes and Practices of Immune Checkpoint Inhibitors in Chinese Patients With Cancer: A National Cross-Sectional Survey

“…For example, the pooled hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) in lung cancer patients treated with PD-1/PD-L1 inhibitors were 0.69 and 0.74, respectively, while the odds ratios (ORs) for treatment-related grade 3–5 adverse events (AEs) were 0.30–0.33 ( Lai et al, 2020 ). Similar results were observed in the treatment of classic Hodgkin’s lymphoma ( Zhang et al, 2019 ), renal cell carcinoma ( Sun et al, 2020 ), urothelial cancer ( Niglio et al, 2019 ), melanoma ( Karlsson and Saleh, 2017 ), and breast cancer ( Vranic et al, 2019 ). The NCCN ( NCCN, 2019a ; NCCN, 2019b ; NCCN, 2020a ; NCCN, 2020b ), ESMO ( Dummer et al, 2015 ; Escudier et al, 2016 ; Novello et al, 2016 ; Haanen et al, 2017 ), and SITC ( Puzanov et al, 2017 ; Rini et al, 2019 ) guidelines support the use of ICIs for various cancer types, with specific indications.…”

The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

“… 36 , 38 Anti-PD-1/PD-L1 treatment, also known as checkpoint inhibition, has recently been particularly popular in many tumor treatment fields. 39 - 43 …”

“…36,38 Anti-PD-1/PD-L1 treatment, also known as checkpoint inhibition, has recently been particularly popular in many tumor treatment fields. [39][40][41][42][43] This study focused on the safety and efficacy of immune checkpoint inhibitors in gastroesophageal cancer. Because of the non-specific symptoms in the early stage, gastric esophageal cancer patients are often diagnosed with advanced disease and the comprehensive treatment is not effective.…”

Triplet Therapy with PD-1 Blockade, Histone Deacetylase Inhibitor, and DNA Methyltransferase Inhibitor Achieves Radiological Response in Refractory Double-Expressor Diffuse Large B-cell Lymphoma with 17p Deletion

“…Programmed cell death protein 1 (PD-1) is a key immune checkpoint receptor that is frequently expressed on tumor-infiltrating T cells in B-cell lymphomas [ 6 ]. In recent years, although therapeutic blockade of PD-1/PD-L1 has shown potential clinical activity in several types of NHL, the efficiency in DLBCL was not as satisfactory as in Classical Hodgkin lymphoma (cHL) [ 2 , 4 , 7 – 10 ]. The diversity of clinical responses to monotherapy with PD-1/PD-L1 inhibitors is in part explained by genetic heterogeneity and the diversity of signal pathways involved in the development of B-NHL [ 8 , 11 ].…”