ECHELON-1 study 3 year update: Frontline brentuximab vedotin with chemotherapy for stage 3/4 classical Hodgkin lymphoma

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Published: 20 Jun 2019
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Dr Andrea Gallamini - Centre Antoine Lacassagne, Nice, France

Dr Andrea Gallamini speaks to ecancer at the 2019 European Hematology Association (EHA) Annual Meeting about the 3 year update from the ECHELON-1 study into frontline brentuximab vedotin with chemotherapy for stage 3/4 classical Hodgkin lymphoma.

He reports that the extended follow up beyond 3 years has shown a consistent advantage of brentuximab vedotin with doxorubicin, vinblastine, and dacarbazine (A plus AVD) over doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).

Dr Gallamini adds that the toxic profile of A plus AVD was acceptable with below 20% of patients continuing to show peripheral neuropathy.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

We will present data tomorrow with the updated results of the international open label phase III clinical trial on the use of brentuximab vedotin plus AVD compared to standard ABVD treatment in advanced stage Hodgkin lymphoma patients. Extended follow-up beyond three years of observation has shown a consistent advantage in the experimental arm which is characterised by standard ABVD in which bleomycin has been taken over by brentuximab vedotin at the dose of 1.2mg/kg days 1 and 15 for twelve times which showed a consistent advantage compared to standard ABVD and a reduction in the risk of disease failure of 30% compared to the standard population treated with ABVD. So this is highly significant.

At the same time the toxic profile of this combination was acceptable with less than 20% of the patients continuing to present with peripheral neuropathy while in the other cases these side effects subsided over time. So at the end, in conclusion, the efficacy versus toxicity profile is quite good for this combination.

Did you find any difference between subgroups or agents?

Yes, patients benefitting most of this treatment are patients with advanced stage and stage 4 presenting with extranodal sites or international prognostic score 4 or more while there was less benefit, lower benefit, in patients aged more than 60 years, between 60 and 75.

How might these results change clinical practice?

In patients with high risk advanced stage Hodgkin lymphoma and high risk of treatment failure this could be an alternative not only to standard treatment but also to PET response adapted new trials which have been run in the early decades of the 2000s showing a benefit compared to standard ABVD. But this approach compares favourably even with the PET adapted strategies.

Which regiment is optimal for elderly patients?

For older patients very interesting results have been published with priming those of brentuximab vedotin alone followed by classical ABVD but for abbreviated courses, only four courses, followed again by brentuximab vedotin alone. This has been published in the last year and seems the most efficacious treatment for such band of age for the patients.

Is there anything you would like to add?

In the next future it will be very interesting to co-administer along with brentuximab vedotin plus AVD new drugs which could improve the cytotoxic activity of brentuximab vedotin as, for instance, new monoclonal antibodies against CD47.