Including brentuximab vedotin in a first-line doxorubicin, vinblastine, and dacarbazine combination therapy (A+AVD) appears to improve overall survival (OS) outcomes among patients with stage III or IV Hodgkin lymphoma, according to research published in The New England Journal of Medicine.
Over the past several decades, patients diagnosed with stage III or IV Hodgkin lymphoma have been treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), which has greatly improved outcomes. Many patients, however, face relapse or have disease refractory to treatment, necessitating other first-line options.
Brentuximab vedotin is a CD30-targeting monoclonal antibody that has previously shown promise in the hematologic cancer setting, including in Hodgkin lymphoma. The randomized phase 3 ECHELON-1 (ClinicalTrials.gov Identifier: NCT01712490) was designed to evaluate the relative safety and efficacy of A+AVD vs ABVD as first-line therapies among patients with stage III or IV disease; a planned interim analysis suggested an OS benefit.
It was, however, previously unclear whether the OS benefit would hold in the long term. For the present paper, researchers conducted a long-term survival analysis of ECHELON-1 to determine whether A+AVD yields improved OS vs ABVD.
Overall, 664 and 670 patients were assigned to the A+AVD and ABVD groups, respectively. The median follow-up for this analysis was 73 months; at this point, 39 and 64 patients in the A+AVD and ABVD groups, respectively, had died, indicating a hazard ratio for death of 0.59 (P =.009).
Analysis suggested that the 6-year OS estimates were 93.9% and 89.4% in the A+AVD and ABVD groups, respectively; progression-free survival was, similarly, improved in the A+AVD group (hazard ratio for progression or death, 0.68; 95% CI, 0.53-0.86).
Patients in the A+AVD group were also less likely to have subsequent therapy or secondary malignancies (23 vs 32 patients with ABVD). Febrile neutropenia was noted with A+ABVD, because of which the researchers recommended primary prophylaxis with granulocyte colony-stimulating factor.
“The treatment of advanced Hodgkin’s lymphoma has been a success story in oncology, but only modest progress has been made in past decades,” the authors wrote in their report. “However, in this trial, treatment with A+AVD resulted in an improvement in both progression-free survival and overall survival.”
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Ansell SM, Radford J, Connors JM, et al. Overall survival with brentuximab vedotin in stage III or IV Hodgkin’s lymphoma. N Engl J Med. 2022;387(4):310-320. doi:10.1056/NEJMoa2206125