Among patients with early-stage, unfavorable Hodgkin lymphoma (HL), first-line brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (BV-AVD) appears to yield improved prognostic outcomes compared with standard doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD), according to research published in the Journal of Clinical Oncology.
A standard prognostic measure in this patient population is early interim [18F]-fluorodeoxyglucose positron emission tomography (PET); this allows clinicians to determine who is likely to be at risk of relapse. For this randomized phase 2 study, researchers evaluated whether 2 cycles of first-line BV-AVD yields improved PET-negative rates compared with ABVD among patients with early-stage, unfavorable HL.
Overall, 113 patients were randomly assigned to the BV-AVD group and 57 patients were assigned to the ABVD group. In the BV-AVD vs ABVD groups, the median age was 29 vs 28 years, respectively, 47% vs 54% of patients were male sex, and 92% vs 93% of patients had Ann Arbor stage II disease.
After 2 treatment cycles, 82.3% (90% CI, 75.3-88) of patients in the BV-AVD arm were PET-negative compared with 75.4% (90% CI, 64.3-84.5) of patients in the ABVD group. Correspondingly, the 2-year progression-free survival (PFS) rates in the BV-AVD vs ABVD groups were 97.3% (95% CI, 91.9-99.1) and 92.6% (95% CI, 81.4-97.2), respectively.
Among patients with high total metabolic tumor volume — which was, in this study, linked with inferior PFS — the 2-year PFS rates were 90.9% (95% CI, 74.4-97.0) in the BV-AVD group vs 70.7% (95% CI, 39.4-87.9) in the ABVD group.
The authors noted, however, that they “observed a higher incidence of hematological toxicities with grade 3-4 neutropenia and febrile neutropenia in patients treated with BV-AVD, but the incidence of infections was only slightly higher compared with ABVD.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures.
Fornecker LM, Lazarovici J, Aurer I, et al. Brentuximab vedotin plus AVD for first-line treatment of early-stage unfavorable Hodgkin lymphoma (BREACH): a multicenter, open-label, randomized, phase II trial. J Clin Oncol. 2023;41(2):327-335. doi:10.1200/JCO.21.01281