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
