Justin Ferdinandus

CONGRESS | #ASH24 | Justin Ferdinandus @jusferdinandus @UKKoeln shares results from the phase II portion of the GHSG HD21 trial of PET-guided BrECADD in older patients with advanced-stage cHL. At a median FU of 23 mo, 12 mo PFS 95.1%, 24 mo PFS 91.5, 12 mo OS 96.2%, 24 mo OS 90.8%. Follow our live feed for more updates: loom.ly/0ezHR9U #lymsm #lymphoma #MedicalCongress

@jryckman3 It seems the objective globally has shifted towards eliminating RT from 1st line HL protocols, which I personally disagree with given the risk-benefit ratio of modern RT… But I may be biased, as I am married to a RadOnc 👀

@jryckman3 Thanks for raising a lot of important comments ;-) I can promise that dedicated analyses of RT details including QA in HD21 are underway although RT was not a primary focus of the trial and as pointed out performed as per SOC (guided by panel recommendation).

Fantastic study! Here are a few comments regarding the radiotherapy subgroup. I hope these comments are well received, as GHSG is exemplary and helps set the global standard of care in these settings! 1) Did this study report the number of PETF(+) cases in the 4c and 6c groups separately? 2) Did this study report 4y PFS outcomes for PETF(+) patients who received consolidative RT compared to those who were PETF(-) and did not receive consolidative RT? - RT details were left to the investigator’s discretion, with 30 Gy to involved areas recommended. There were no RT details, RT quality assurance, or standardization in the protocol. - Patients who received RT were described as “subjected” to radiotherapy in the protocol, but this term wasn’t used when discussing additional chemotherapy in the PET2(+) subgroup. Aren’t patients in the PET2(+) subgroup also “subjected” to additional chemotherapy? - The discussion mentions that RT may not be necessary for D4+, despite not reporting 4-year PFS for the PETF(-) subgroup (~83%; who did not receive RT) and the PETF(+) subgroup (~17%; most, or ~85%, of whom received RT). - This indicates a potential bias against RT. I look forward to another report with detailed radiotherapy information in the future, as it is very likely RT minimized (or eliminated) the 4-year PFS differences in the PETF(-) vs. PETF(+) subgroups, regardless of whether it was 4c or 6c. However, it's disheartening to see the lack of RT details. These are critical for understanding if RT compensated for potential differences in 4-year PFS in the PETF(+) vs. PETF(-) subgroups, regardless of PET2 status (read: 4c or 6c total). Looking forward to insights from heme #radonc experts like @brandon_imber, @JamesBatesMD, @JillGunther, @A_CT_SimMDJD, @ChelseaPinnix, and @BouthainaDabaja. Maybe they'll say I'm overly focused on a regimen not widely used in the US, or perhaps I'm too sensitive to how radiotherapy is portrayed in many heme studies. Either way, I hope this generates a productive discussion. Nuanced radiotherapy details aside, I am so glad our patients have better systemic therapy treatment options!

New Episode! Tune in for #ASCO24 #EHA24 #Lymphoma updates with @gloria_iacoboni, where we discuss: STARGLO ECHO HD-21 EPCORE-NHL 5 EPCOR-CLL 1 and more! share.transistor.fm/s/27f9ca64 @Eddie_Cliff Check out this short clip on critical appraisal of STARGLO results! #lymsm

Full text: sciencedirect.com/science/articl…

🚨 HD21 results now finally published in the @TheLancet : BrECADD is better tolerated and more efficient than eBEACOPP as PET-guided treatment for patients with adv. Hodgkin Lymphoma! #lymsm

@B_von_Tresckow @BroeckelmannPJ @Dr_Daniel_Molin @HallekMichael @ALLGtrials @UKKoeln @UniCologne

Top quality session with great speakers on Hodgkin lymphoma at @EHA_Hematology 2024 just started.

Ferdinandus - gondal recovery in HD21 - 80% of ITT pts assessed - FSH recovery & parenthood rate - Recovery after BrECADD much better than after eBEAOCPP for men & women (& parenthood) - But still effect of cycle no. & age v encouraging data for our pts. #EHA2024 #lymsm

I just can’t recommend #CRTH highly enough. Apply now, thank me later! Huge thanks to @EHA_Hematology for creating this platform.

Going from #CRTH scholar to faculty, @DottorClaudio talks about his experience following the program and what new scholars can expect. Tune in soon for the full video. The call for Clinical Research Training in hematology is now open: EHA.fyi/CRTH25

If you are at #EHA2024 in sunny madrid and interested in HL and PROs come see me at our poster on HRQoL between BrECADD and eBEACOPP. ✌🏽 #lymsm

@frbertoni @CascioneLuciano @IOR_Bellinzona @USI_en @EnteOspedaliero @ISBSIB Congratulations! Hoping to see a revival of radionuclide therapy in lymphoma. :-)

the preprint of our work in lymphomas with the CD37 targeting 177Lu-lilotomab Satetraxetan is out⁩. thanks to all the collaborators. ⁦@CascioneLuciano⁩ @IOR_Bellinzona⁩ ⁦@USI_en ⁦@EnteOspedaliero⁩ ⁦@ISBSIB⁩ biorxiv.org/content/10.110…

@vadim_lesan @majorajay That is usually correct, but infact not true for HL ;-) 90% vs. 95% roughly translates to HR 2.0. At least in my opinion 5% is not a school bus. It is therefore already very tough to run NI-trials in HL. Keep in mind HD21 had to recruit 1500 pts for this NI-margin.

@majorajay Don’t forget that it was a non inferiority trial. With a HR of 1.69 one can park a whole school bus in there and still have non inferiority!

Results GHSG HD21 BrECADD v eBEACOPP in 1L cHL #ASCO24: - 1500 pts, med age 31, Stage IIB 17%, rest adv stage - PFS superior in BrE arm: 4 yr 94% vs 91% (!!!) - less tox & neuropathy with BrE - 96% gonadal recovery with BrE (73% with escB) New standard of care in cHL? #lymsm

@majorajay @prp_diciaccio Sure! Roughly speaking, childbirth rates among all women receiving BrECADD are very similar to ABVD-treated (i.e. PET2-neg, no relapse) women in RATHL. Stay tuned, as I’ll be discussing HD21 fertility in depth soon at EHA24 ✌🏽

@prp_diciaccio Any insight on this, @jusferdinandus?

@majorajay @priyankapophali @eha24 C30, FA12 (knowing fatigue is a long-term problem in HL) and a more general „life situation“ questionnaire. In future trials, we are implementing PRO-CTCAE to assess side effects more accurately.

@jusferdinandus @priyankapophali @eha24 Very much looking forward to it! What other PROs were included in the HD21 protocol?

Great question by Dr. @priyankapophali regarding toxicity grading in HD 21 and persistence of low-grade toxicities. I disagree with speaker's stipulation of "clinically-relevant" neuropathy; that can only be measured and assessed with PROs. #ASCO24

@dgermain21 Yes, absolutely they can (no day 8 infusions with BrECADD - so quite a long break from infusions)! Others back to work very early. But keep in mind that socioeconomic variables (including social insurance) heavily influence work rates. Is there data on sick leave with Nivo-AVD?

Do people have a sense whether patients could still work or go to school during BrECADD? They certainly can with Nivo-AVD, and I’d say it’s a maybe/probably with escBEACOPP.

I can't recommend highly enough this amazing opportunity for training in clinical trial design and delivery by @EHA_Hematology Being part of the #CRTH24 cohort has been a fantastic experience so far Do apply below with a clinical trial idea ⬇️⬇️⬇️ ehaweb.org/research/resea…

@graham74GC @alex_epi_tria Exactly, we need to limit unnecessary exposure through individualised treatment. That being said, there are just 160 mg/m2 in 4x BrECADD ;-)

@alex_epi_tria Correct. And agree - it’s a very active drug in Hodgkin. However we can design studies to minimise exposure by adding in novel agents - esp those which chemosensitise. Eg - do all adv stage pts really need 6x Nivo-AVD?

Fascinating & important study: Neppelenbroek et al, Dutch registry study. • med FU 21.6y! • Hodgkin pts, > 200mg/m2 dox assoc with 1.5x ⬆️ risk breast cancer • not modified by age of exposure or radiotherapy Underscores need to optimise chemo use. ascopubs.org/doi/10.1200/JC…