1. Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial
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Steven Horwitz, Owen A O'Connor, Barbara Pro, Tim Illidge, Michelle Fanale, Ranjana Advani, Nancy L Bartlett, Jacob Haaber Christensen, Franck Morschhauser, Eva Domingo-Domenech, Giuseppe Rossi, Won Seog Kim, Tatyana Feldman, Anne Lennard, David Belada, Árpád Illés, Kensei Tobinai, Kunihiro Tsukasaki, Su-Peng Yeh, Andrei Shustov, Andreas Hüttmann, Kerry J Savage, Sam Yuen, Swaminathan Iyer, Pier Luigi Zinzani, Zhaowei Hua, Meredith Little, Shangbang Rao, Joseph Woolery, Thomas Manley, Lorenz Trümper, David Aboulafia, Onder Alpdogan, Kiyoshi Ando, Luca Arcaini, Luca Baldini, Naresh Bellam, Nancy Bartlett, Dina Ben Yehuda, Fabio Benedetti, Peter Borchman, Dominique Bordessoule, Pauline Brice, Javier Briones, Dolores Caballero, Angelo Michele Carella, Hung Chang, June Weon Cheong, Seok-Goo Cho, Ilseung Choi, Sylvain Choquet, Andrei Colita, Angela Giovanna Congui, Francesco D'amore, Nam Dang, Kelly Davison, Sophie de Guibert, Peter de Nully Brown, Vincent Delwail, Judit Demeter, Francesco di Raimondo, Young Rok Do, Eva Domingo, Michael Douvas, Martin Dreyling, Thomas Ernst, Keith Fay, Silvia Fernandez Ferrero, Ian Winchester Flinn, Andres Forero-Torres, Christopher Fox, Jonathan Friedberg, Noriko Fukuhara, Jose Garcia-Marco, Jorge Gayoso Cruz, Jose Gomez Codina, Remy Gressin, Andrew Grigg, Ronit Gurion, Corinne Haioun, Roman Hajek, Mathias Hanel, Kiyohiko Hatake, Robert Hensen, Netanel Horowitz, Andreas Huttmann, Arpad Illes, Kenichi Ishizawa, Miguel Islas-Ohlmayer, Eric Jacobsen, Murali Janakiram, Wojciech Jurczak, Mark Kaminski, Koji Kato, Ilya Kirgner, Ching-Yuan Kuo, Mihaela Cornelia Lazaroiu, Katell Le Du, Jong-Seok Lee, Steven LeGouill, Paul LaRosee, Itai Levi, Brian Link, Herve Maisonneuve, Dai Maruyama, Jiri Mayer, John McCarty, Pam McKay, Yosuke Minami, Heidi Mocikova, Enrica Morra, Javier Munoz, Hirokazu Nagai, Owen O'Connor, Stephen Opat, Ruth Pettengell, Antonio Pezzutto, Michael Pfreundschuh, Andrzej Pluta, PierLuigi Porcu, Hang Quach, Alessandro Rambaldi, William Renwick, Ruben Reyes, Antonia Rodriguez Izquierdo, Jia Ruan, Chiara Rusconi, Gilles Salles, Armando Santoro, Jose Sarriera, Kerry Savage, Hirohiko Shibayama, Cheolwon Suh, Anna Sureda, Mitsune Tanimoto, Masafumi Taniwaki, Herve Tilly, Marek Trneny, Lorenz Trumper, Norifumi Tsukamoto, Umberto Vitolo, Jan Walewski, Eckhart Weidmann, Martin Wilhelm, Mathias Witzens-Harig, Abdulraheem Yacoub, Kazuhito Yamamoto, Sung-Soo Yoon, Hwan Jung Yun, Jasmine Zain, Horwitz, Steven, O'Connor, Owen A, Pro, Barbara, Illidge, Tim, Fanale, Michelle, Advani, Ranjana, Bartlett, Nancy L, Christensen, Jacob Haaber, Morschhauser, Franck, Domingo-Domenech, Eva, Rossi, Giuseppe, Kim, Won Seog, Feldman, Tatyana, Lennard, Anne, Belada, David, Illés, Árpád, Tobinai, Kensei, Tsukasaki, Kunihiro, Yeh, Su-Peng, Shustov, Andrei, Hüttmann, Andrea, Savage, Kerry J, Yuen, Sam, Iyer, Swaminathan, Zinzani, Pier Luigi, Hua, Zhaowei, Little, Meredith, Rao, Shangbang, Woolery, Joseph, Manley, Thoma, Trümper, Lorenz, and ECHELON-2 Study Group
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Male ,Immunoconjugates ,Lydia Becker Institute ,medicine.medical_treatment ,Medizin ,030204 cardiovascular system & hematology ,CHOP ,Gastroenterology ,Cyclophosphamide/administration & dosage ,0302 clinical medicine ,International Prognostic Index ,Prednisone/administration & dosage ,Prednisone ,Antineoplastic Combined Chemotherapy Protocols ,Vincristine/administration & dosage ,030212 general & internal medicine ,Brentuximab vedotin ,Brentuximab Vedotin ,Manchester Cancer Research Centre ,General Medicine ,Orvostudományok ,Middle Aged ,3. Good health ,Antineoplastic Agents/administration & dosage ,Intention to Treat Analysis ,Immunoconjugates/administration & dosage ,Vincristine ,Lymphoma, Large-Cell, Anaplastic ,Female ,Immunologic Factors/administration & dosage ,medicine.drug ,Adult ,medicine.medical_specialty ,Antineoplastic Agents ,Lymphoma, T-Cell ,Klinikai orvostudományok ,Lymphoma, Large-Cell, Anaplastic/drug therapy ,Article ,Disease-Free Survival ,03 medical and health sciences ,Double-Blind Method ,Internal medicine ,ResearchInstitutes_Networks_Beacons/lydia_becker_institute_of_immunology_and_inflammation ,medicine ,Humans ,Immunologic Factors ,Cyclophosphamide ,Aged ,Chemotherapy ,business.industry ,ResearchInstitutes_Networks_Beacons/mcrc ,Doxorubicin/administration & dosage ,medicine.disease ,Peripheral T-cell lymphoma ,Brentuximab vedotin , CD30-positive peripheral T-cell lymphoma, ECHELON-2 ,Doxorubicin ,Antineoplastic Combined Chemotherapy Protocols/therapeutic use ,business ,Febrile neutropenia - Abstract
BACKGROUND: Based on the encouraging activity and manageable safety profile observed in a phase 1 study, the ECHELON-2 trial was initiated to compare the efficacy and safety of brentuximab vedotin, cyclophosphamide, doxorubicin, and prednisone (A+CHP) versus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) for the treatment of CD30-positive peripheral T-cell lymphomas.METHODS: ECHELON-2 is a double-blind, double-dummy, randomised, placebo-controlled, active-comparator phase 3 study. Eligible adults from 132 sites in 17 countries with previously untreated CD30-positive peripheral T-cell lymphomas (targeting 75% with systemic anaplastic large cell lymphoma) were randomly assigned 1:1 to receive either A+CHP or CHOP for six or eight 21-day cycles. Randomisation was stratified by histological subtype according to local pathology assessment and by international prognostic index score. All patients received cyclophosphamide 750 mg/m2 and doxorubicin 50 mg/m2 on day 1 of each cycle intravenously and prednisone 100 mg once daily on days 1 to 5 of each cycle orally, followed by either brentuximab vedotin 1·8 mg/kg and a placebo form of vincristine intravenously (A+CHP group) or vincristine 1·4 mg/m2 and a placebo form of brentuximab vedotin intravenously (CHOP group) on day 1 of each cycle. The primary endpoint, progression-free survival according to blinded independent central review, was analysed by intent-to-treat. This trial is registered with ClinicalTrials.gov, number NCT01777152.FINDINGS: Between Jan 24, 2013, and Nov 7, 2016, 601 patients assessed for eligibility, of whom 452 patients were enrolled and 226 were randomly assigned to both the A+CHP group and the CHOP group. Median progression-free survival was 48·2 months (95% CI 35·2-not evaluable) in the A+CHP group and 20·8 months (12·7-47·6) in the CHOP group (hazard ratio 0·71 [95% CI 0·54-0·93], p=0·0110). Adverse events, including incidence and severity of febrile neutropenia (41 [18%] patients in the A+CHP group and 33 [15%] in the CHOP group) and peripheral neuropathy (117 [52%] in the A+CHP group and 124 [55%] in the CHOP group), were similar between groups. Fatal adverse events occurred in seven (3%) patients in the A+CHP group and nine (4%) in the CHOP group.INTERPRETATION: Front-line treatment with A+CHP is superior to CHOP for patients with CD30-positive peripheral T-cell lymphomas as shown by a significant improvement in progression-free survival and overall survival with a manageable safety profile.FUNDING: Seattle Genetics Inc, Millennium Pharmaceuticals Inc, a wholly owned subsidiary of Takeda Pharmacuetical Company Limited, and National Institutes of Health National Cancer Institute Cancer Center.
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- 2019