跳轉到

Q1. Which statement about classic Hodgkin lymphoma (cHL) is CORRECT? (1) KEYNOTE-204 demonstrates that pembrolizumab is superior to brentuximab vedotin with meaningful improvement in PFS in relapsed/refractory cHL. (2) cHL in older adult patients (>60 years of age) is associated with worse disease outcomes. (3) The use of brentuximab vedotin as consolidation therapy following HDT/ASCR was associated with improving PFS. (4) Involved-site RT and involved-node RT are being used as alternatives to involved-field RT in an effort to restrict the size of the RT fields.

  • (A) (1) (2) (3) are correct please choose
  • (B) (1) (3) are correct please choose
  • (C) (2) (4) are correct please choose
  • (D) (4) is correct please choose
  • (E) (1) (2) (3) (4) are correct please choose
點此顯示正解

(E) (1) (2) (3) (4) are correct please choose

詳解

Based on the search results, I can now analyze this board question:

Why (E) is the CORRECT Answer

(E) is correct because all four statements (1)(2)(3)(4) are true about classic Hodgkin lymphoma.

Analysis of Each Statement

Statement (1) - TRUE: KEYNOTE-204 demonstrated that pembrolizumab is superior to brentuximab vedotin with meaningful improvement in PFS in relapsed/refractory cHL. The trial showed median PFS of 13.2 months for pembrolizumab versus 8.3 months for brentuximab vedotin (HR 0.65, 95% CI 0.48-0.88; p=0.0027), representing a statistically significant and clinically meaningful improvement13. The study concluded that pembrolizumab should be the preferred treatment option for patients with relapsed or refractory cHL who have relapsed post-autologous HSCT or are ineligible for autologous HSCT1.

Statement (2) - TRUE: cHL in older adult patients (>60 years) is associated with worse disease outcomes. While the search did not return specific sources on this topic, this is well-established in the literature that older age is an adverse prognostic factor in cHL, with older patients experiencing inferior outcomes due to both disease biology and reduced tolerance to intensive chemotherapy regimens.

Statement (3) - TRUE: The use of brentuximab vedotin as consolidation therapy following HDT/ASCR was associated with improving PFS. The pivotal AETHERA trial demonstrated that brentuximab vedotin consolidation significantly improved PFS compared with placebo (median PFS 42.9 months versus 24.1 months; HR 0.57, 95% CI 0.40-0.81; p=0.0013), representing a 43% reduction in the risk of disease progression or death[7][8]. Real-world evidence from 1504 patients across 23 studies corroborated these findings with pooled 2-year PFS of 74.2% and 5-year PFS of 65.8%[^6]. This consolidation approach is now widely used in standard practice for patients with adverse prognostic factors[^9].

Statement (4) - TRUE: Involved-site RT (ISRT) and involved-node RT (INRT) are being used as alternatives to involved-field RT (IFRT) in an effort to restrict the size of RT fields. This represents the modern evolution of radiation therapy in Hodgkin lymphoma, with progressive reduction in radiation field size to minimize long-term toxicity while maintaining disease control. ISRT and INRT target smaller volumes than traditional IFRT, reducing exposure of normal tissues and late effects.

詳解 · 中文翻譯

根據搜索結果，我現在可以分析此董事會問題：

為什麼 (E) 是正確答案

(E) 正確，因為所有四個敘述 (1)(2)(3)(4) 都是真實的關於經典霍奇金淋巴瘤。

每個敘述的分析

敘述 (1) - 真實：KEYNOTE-204 證明pembrolizumab 優於 brentuximab vedotin，在復發/難治 cHL 中無進展生存期有意義的改善。試驗顯示pembrolizumab 中位 PFS 為 13.2 個月對 brentuximab vedotin 的 8.3 個月（HR 0.65，95% CI 0.48-0.88；p=0.0027），代表統計學顯著和臨床意義的改善13。研究結論是 pembrolizumab 應該是對於復發或難治 cHL 患者（已在自體造血幹細胞移植後復發或不符合自體造血幹細胞移植條件）的首選治療選項1。

敘述 (2) - 真實：年長患者（>60 歲）中的 cHL 與更差的疾病預後相關。雖然搜索未返回此題的特定來源，但文獻中明確確立年齡較大是 cHL 的不良預後因素，年長患者因疾病生物學和對密集化療方案的耐受性降低而有較差的預後。

敘述 (3) - 真實：使用 brentuximab vedotin 作為 HDT/ASCR 後的鞏固治療與改善 PFS 相關。樞紐性 AETHERA 試驗證明 brentuximab vedotin 鞏固相比安慰劑顯著改善 PFS（中位 PFS 42.9 個月對 24.1 個月；HR 0.57，95% CI 0.40-0.81；p=0.0013），代表疾病進展或死亡風險降低 43%[7][8]。來自 23 項研究中 1504 名患者的真實世界證據證實了這些發現，池化 2 年 PFS 為 74.2%，5 年 PFS 為 65.8%[6]。此鞏固方法現在廣泛用於不良預後因素患者的標準實踐[9]。

敘述 (4) - 真實：受累部位 RT（ISRT）和受累淋巴結 RT（INRT）正被用作受累野 RT（IFRT）的替代方案以限制 RT 野的大小。這代表霍奇金淋巴瘤放射治療的現代演變，隨著放射治療野大小的漸進式減少以最小化長期毒性同時保持疾病控制。ISRT 和 INRT 靶向比傳統 IFRT 更小的體積，減少正常組織的暴露和晚期效應。

參考文獻 (AMA)

  1. Kuruvilla J, Ramchandren R, Santoro A, et al. Pembrolizumab Versus Brentuximab Vedotin in Relapsed or Refractory Classical Hodgkin Lymphoma (KEYNOTE-204): An Interim Analysis of a Multicentre, Randomised, Open-Label, Phase 3 Study. The Lancet. Oncology. 2021;22(4):512-524. doi:10.1016/S1470-2045(21)00005-X. PMID:33721562. ↩↩↩↩

  2. Moskowitz CH, Nademanee A, Masszi T, et al. Brentuximab Vedotin as Consolidation Therapy After Autologous Stem-Cell Transplantation in Patients With Hodgkin's Lymphoma at Risk of Relapse or Progression (AETHERA): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial. Lancet (London, England). 2015;385(9980):1853-62. doi:10.1016/S0140-6736(15)60165-9. PMID:25796459. ↩

  3. Scott LJ. Brentuximab Vedotin: A Review in CD30-Positive Hodgkin Lymphoma. Drugs. 2017;77(4):435-445. doi:10.1007/s40265-017-0705-5. PMID:28190142. ↩↩

  4. Sureda A, Pavlovsky A, Haidar D, et al. Real-World Outcomes of Brentuximab Vedotin as Consolidation Therapy After Autologous Stem Cell Transplantation in Relapsed/Refractory Hodgkin Lymphoma: A Systematic Review and Meta-Analysis. Bone Marrow Transplantation. 2025;60(6):820-831. doi:10.1038/s41409-025-02557-7. PMID:40200006. ↩

  5. Brice P, de Kerviler E, Friedberg JW. Classical Hodgkin Lymphoma. Lancet (London, England). 2021;398(10310):1518-1527. doi:10.1016/S0140-6736(20)32207-8. PMID:33493434. ↩

Slide annotations

Phase 3 AETHERA trial, Lancet. 2015; Lancet Oncol. 2021

Figures