HL

Five-year follow-up of ABVD + brentuximab vedotin, or AVD + brentuximab vedotin in the treatment of advanced cHL

In a letter to the editor of Blood published online in July ahead of print, Joseph M. Connors, of the British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, Canada, and colleagues presented five-year follow-up data on the use of Brentuximab Vedotin (BV) in combination with ABVD or AVD in a cohort of 51 previously untreated advanced stage classical Hodgkin Lymphoma patients. In the previously reported data set from this study it was concluded that the addition of BV to ABVD in HL patients resulted in ‘excessive pulmonary toxicity’ when compared to patients being treated with this combination, but without bleomycin2. A follow-up study was therefore instigated to determine the longer-term safety and efficacy data comparing BV with either ABVD or AVD.

Key Highlights:

  • Previous study:
    • 51 pts recruited: 25 pts received ABVD+BV, 26 pts received AVD+BV
    • Dosing:
      • BV every two weeks, with dose escalation from 0.6 mg/kg to 1.2 mg/kg (I.V.)
      • In the AVD group, all patients started at 1.2 mg/kg BV (I.V.)
    • In the ABVD group, two patients died from pulmonary toxicity, and one withdrew consent
  • This study:
  • 48 pts included in five-year follow-up: 22 pts who received ABVD+BV, 26 pts who received AVD+BV
  • Median follow-up = 66 months (45 – 84 months)
  • Pts who relapsed: ABVD+BV = 3/22, AVD+BV = 2/26. All relapsing pts had HD chemotherapy and AutoSCT with four being in second remission
  • No further deaths reported, one patient with secondary relapse receiving palliative care
  • Efficacy at five-years follow-up:
    • Failure Free Survival: ABVD+BV = 79%, AVD+BV = 92%
    • OS: ABVD+BV = 92%, AVD+BV = 100%
  • However, there was some disparity between the International Prognostic Scores (IPS) between groups which was not commented upon. IPS 4–7 accounted for 80% of the ABVD+BV group (20/25), but only 54% of the AVD+BV group (14/26)

In conclusion, the authors stated that the combination of AVD+BV is safe, and results in ‘excellent and durable control’ of cHL. The authors also state that the possible superiority of the combination of AVD+BV compared with ABVD alone is being assessed in the ECHELON trial.

Abstract: N/A

References:
  1. Connors J.M. et al. Five-year follow-up of brentuximab vedotin combined with ABVD or AVD for advanced stage classical Hodgkin lymphoma. Blood. 2017 Jul. [ePub ahead of print 2017 July 21]. DOI: https://doi.org/10.1182/blood-2017-05-784678.
  2. Younes A. et al. Brentuximab vedotin combined with ABVD or AVD for patients with newly diagnosed Hodgkin's lymphoma: a phase 1, open-label, dose-escalation study. Lancet Oncology.2013 Dec;14(13):1348-56. DOI: 10.1016/S1470-2045(13)70501-1.