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Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study.
- Source :
-
Blood [Blood] 2020 Mar 05; Vol. 135 (10), pp. 735-742. - Publication Year :
- 2020
-
Abstract
- The phase 3 ECHELON-1 study demonstrated that brentuximab vedotin (A) with doxorubicin, vinblastine, and dacarbazine (AVD; A+AVD) exhibited superior modified progression-free survival (PFS) vs doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for frontline treatment of patients with stage III/IV classical Hodgkin lymphoma (cHL). Maturing positron emission tomography (PET)-adapted trial data highlight potential limitations of PET-adapted approaches, including toxicities with dose intensification and higher-than-expected relapse rates in PET scan after cycle 2 (PET2)-negative (PET2-) patients. We present an update of the ECHELON-1 study, including an exploratory analysis of 3-year PFS per investigator. A total of 1334 patients with stage III or IV cHL were randomized 1:1 to receive 6 cycles of A+AVD (n = 664) or ABVD (n = 670). Interim PET2 was required. At median follow-up of 37 months, 3-year PFS rates were 83.1% with A+AVD and 76.0% with ABVD; 3-year PFS rates in PET2- patients aged <60 years were 87.2% vs 81.0%, respectively. A beneficial trend in PET2+ patients aged <60 years on A+AVD was also observed, with a 3-year PFS rate of 69.2% vs 54.7% with ABVD. The benefit of A+AVD in the intent-to-treat population appeared independent of disease stage and prognostic risk factors. Upon continued follow-up, 78% of patients with peripheral neuropathy on A+AVD had either complete resolution or improvement compared with 83% on ABVD. These data highlight that A+AVD provides a durable efficacy benefit compared with ABVD for frontline stage III/IV cHL, consistent across key subgroups regardless of patient status at PET2, without need for treatment intensification or bleomycin exposure. This trial was registered at www.clinicaltrials.gov as #NCT01712490 (EudraCT no. 2011-005450-60).<br /> (© 2020 by The American Society of Hematology.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Bleomycin therapeutic use
Brentuximab Vedotin adverse effects
Dacarbazine administration & dosage
Dacarbazine adverse effects
Dacarbazine therapeutic use
Doxorubicin administration & dosage
Doxorubicin adverse effects
Doxorubicin therapeutic use
Female
Follow-Up Studies
Hodgkin Disease mortality
Hodgkin Disease pathology
Humans
Intention to Treat Analysis
Male
Middle Aged
Neoplasm Staging
Survival Analysis
Treatment Outcome
Vinblastine administration & dosage
Vinblastine adverse effects
Vinblastine therapeutic use
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Brentuximab Vedotin administration & dosage
Hodgkin Disease drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0020
- Volume :
- 135
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 31945149
- Full Text :
- https://doi.org/10.1182/blood.2019003127