A PILOT STUDY OF BRENTUXIMAB VEDOTIN AND AVD CHEMOTHERAPY FOLLOWED BY 20 GY INVOLVED‐SITE RADIOTHERAPY IN EARLY STAGE, UNFAVORABLE RISK HODGKIN LYMPHOMA

Abstract

Results: Two hundred thirty-four CD30+ HL patients were treated.Best response was observed after a median of 4 cycles in 140 patients (59.8%): 74 (31.6%) patients obtained a complete response (CR) and 66 (28.2%) achieved a partial response (PR); overall response rate at the end of the treatment was 48.3% (62 CR and 51 PR). The best response rate was higher in the elderly subset (>60 y): 14 (50%) CR and 5 (17.8%) PR. Disease free survival was 26.3% at 3 years and progression free survival 31.9% at 4.5 years. We identified 30 long-term responders (patients with a response ≥12 months) of whom 18 are still in CR, 7 with a consolidative SCT, and 11 without any consolidative procedure. Duration of response did not differ who achieved at least PR and then either did or did not undergo consolidative SCT. Overall, the treatment was well tolerated in everyday clinical practice, and the toxicity profile was closely similar to the previously published data; no death has been linked to BV-induced toxicity. Conclusions:The results of this large retrospective study of 234 relapse/refractory HL in the daily practice support the BV efficacy with manageable toxicity superimposable to the one reported in clinical trials results; in particular, there is the confirmation of the similar activity in different settings, eg, in elderly patients, and of the response duration independently by the transplant consolidation. The relevance of the CR status after 4 cycles and the role of BV as a bridge to ASCT for the chemorefractory patients were also pointed up.

Balancing risk and benefit in early-stage classical Hodgkin lymphoma

“…Although results of more limited RT field, PET-guided RT, and longer follow-up for PFS/OS are pending, the combination of BV-AVD seems to be safe and effective, warranting future research. 46 This active trial landscape reflects the quest to optimally balance risks and benefits associated with therapy for limited-stage HL. However, only randomized phase 3 trials can change standards of care in this highly curable patient group.…”

Current advances in Hodgkin's lymphoma

“… 24 In a second cohort of this study, the ISRT dose was reduced to 20 Gy to reduce toxicity with similar results. 25 This study suggests that this combination is highly effective in patients in the early-stage setting in addition to the advanced-stage setting.…”

Advances in CD30- and PD-1-targeted therapies for classical Hodgkin lymphoma

“…The response rates were identical, with 90% (26/29) and 93% (27/29) of patients being PET negative after 2 and 4 cycles of therapy, respectively. All 28 patients who completed all therapies achieved CR [ 35 ]. Finally, an ongoing randomized phase 2 trial by the Lysa-FIL-EORTC intergroup is comparing 4 cycles of brentuximab vedotin plus AVD with ABVD followed by 30 Gy of involved-node radiation therapy (INRT) in stage I–II HL with unfavorable risk factors.…”