Dr. Kuruvilla on the Safety of Pembrolizumab in Classical Hodgkin Lymphoma

John Kuruvilla, MD, FRCPC, a clinician investigator in the Cancer Clinical Research Unit at Princess Margaret Cancer Centre, discusses the safety of pembrolizumab (Keytruda) versus brentuximab vedotin (Adcetris) in classical Hodgkin lymphoma (CHL).

At the 2020 ASCO Virtual Scientific Program, the phase 3 KEYNOTE-204 trial enrolled patients with CHL who relapsed following an autologous stem cell transplant or were ineligible for transplant. They were randomized to 35 cycles of either pembrolizumab or brentuximab vedotin. 

The toxicity is important to consider because both drugs have different safety profiles. It is known that when the antibody-drug conjugate brentuximab vedotin is combined with chemotherapy, that can contribute to peripheral neuropathy, says Kuruvilla; this was shown in the control arm. However, patients recovered from that event and were still able to do reasonably well, adds Kuruvilla.

In the experimental arm with pembrolizumab, it was known that there were going to be some potential toxicities, adds Kuruvilla. The common immune-related toxicities reported with the agent, which are generally mild and grade 1/2, were as expected. The more worrisome toxicity is pneumonitis, which has been described with this class of agent. In general, approximately 10%-11% of those who received pembrolizumab experienced this event. Half of these events were grades 1/2 and the other half were grade 3/4. Patients who experienced pneumonitis were successfully managed with the use of corticosteroids, although a few patients required discontinuation.

Overall, the effect was still broad no treatment-related deaths from toxicity were reported. Given what was known about this class of agent, toxicity effects the minority while the majority still benefits, concludes Kuruvilla.