Topline  Presentation Points

Overview of response adaptation trial data: 

  • Incorporate geriatric assessment if feasible 
    • Medical optimization 
  • Discuss goals of care 
    • If palliative, early involvement 
  • If fit for chemotherapy, determine cycles of treatment based on stage
  • Determine feasibility of bleomycin usage, do not use if concerns
  • Favour CMT approach as secondary malignancy risk is lower (but think of cardiovascular risk)
  • Can consider PET2 for prognostic value, omission of bleomycin 
    • Concern of escalation in advanced patients, but could potentially incorporate RT 
  • If BV available, G-CSF usage, sequential approach may mitigate toxicity 

Optimal Approaches for RR-cHL in elderly 

  • Important to recognize goals of care (ie. if potentially curative or not)
  • Salvage and ASCT can be considered in a select(ed) group of patients
  • No great data for novel combinations in older patients
  • H2H comparison of pembro with BV favours anti-PD1 but access is challenging currently in Canada for second-line therapy 
    • Opportunity for extended interval of dosing (ie. Q4-6 weeks) which is an added benefit if transit to the cancer centre is challenging
  • Good prospective data in older RR-HL is lacking. 
  • ASCT outcomes in elderly HL: PMH Age 60-65 
    • ASCT appears feasible in selected patients  
    • Currently considering candidacy based on fitness as with other lymphomas 

No clear Standard of Care in RR-cHL patients ineligible for ASCT

  • Optimal approach to manage patients with comorbidity or advanced age / lack of response to treatment is not defined 
    • Radiotherapy an option for localized disease 
    • Non-cross resistant chemotherapy can be used (COPP or other) 
    • Trials of novel agents often have small number of patients that are elderly or have significant comorbidities that preclude ASCT