Population Pharmacokinetics and Exposure Safety Analyses of Nivolumab in Patients With Relapsed or Refractory Classical Hodgkin Lymphoma

Nivolumab, a fully human immunoglobulin G4 monoclonal anti-programmed death-1 antibody, has demonstrated clinical benefits in multiple tumors, including classical Hodgkin lymphoma. The aim of this study was to characterize the pharmacokinetics (PK) of nivolumab in patients with classical Hodgkin lymphoma using a population approach and to assess the exposure-response (E-R) relationship for safety, thereby supporting the dose recommendation in patients with classical Hodgkin lymphoma. Nivolumab PK and the effect of covariates were consistent with that observed in solid tumors, except that baseline clearance of nivolumab was lower in patients with classical Hodgkin lymphoma by 28%. The E-R analysis for safety, characterized by a Cox proportional hazards model, indicated that the resulting increased nivolumab exposure (average concentration after the first dose) was not a significant predictor of the risk of grade 3 drug-related adverse events. Given the acceptable safety profile and observed benefit (65% objective response rate) with the nivolumab 3mg/kg every2week dosing regimen for classical Hodgkin lymphoma, together with the flat E-R safety relationship, nivolumab demonstrated a favorable benefit-risk profile across the range of exposures of 3mg/kg every 2weeks in patients with classical Hodgkin lymphoma. Additional model-based simulation suggested that a flat dose of 240mg every 2weeks was predicted to produce similar exposures to that of 3mg/kg every 2weeks. Therefore, nivolumab 240mg every 2weeks is the recommended dosing regimen in the classical Hodgkin lymphoma population.