Adding Antibody-Drug Conjugate to First-Line Treatment of Advanced Classical Hodgkin Lymphoma

Key Points

  • In the first-line treatment of classical Hodgkin lymphoma, BrECADD and BrECAPP showed similar efficacy.
  • BrECADD had a better toxicity profile. 

As reported by Eichenauer et al in The Lancet Oncology, the final results of a phase II German Hodgkin Study Group trial showed similar efficacy but a better toxicity profile for BrECADD (brentuximab vedotin [Adcetris], etoposide, doxorubicin, cyclophosphamide, dacarbazine, dexamethasone) vs BrECAPP (brentuximab vedotin, etoposide, doxorubicin, cyclophosphamide, procarbazine [Matulane], prednisone) in the first-line treatment of classical Hodgkin lymphoma.

Study Details

The open-label randomized trial compared the escalated BEACOPP (eBEACOPP; bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) variants in patients aged 18 to 60 years with newly diagnosed disease, with 52 evaluable patients receiving 6 cycles of BrECADD and 49 receiving 6 cycles of BrECAPP. BrECADD was given as brentuximab vedotin at 1.8 mg/kg on day 1, etoposide at 150 mg/m² on days 2 to 4, doxorubicin at 40 mg/m² on day 2, cyclophosphamide at 1,250 mg/m² on day 2, dacarbazine at 250 mg/m² on days 3 to 4, and dexamethasone at 40 mg on days 2 to 5. BrECAPP was given as brentuximab vedotin at 1.8 mg/kg on day 1, etoposide at 200 mg/m² on days 2 to 4, doxorubicin at 35 mg/m² on day 2, cyclophosphamide at 1,250 mg/m² on day 2, procarbazine at 100 mg/m² on days 2 to 8, and prednisone at 40 mg/m² on days 2 to 15. The coprimary endpoints were complete response after chemotherapy and complete remission as final treatment outcome.

Response Rates

The median follow-up was 17 months. For the BrECAPP vs BrECADD groups, complete response occurred in 86% vs 88%, and complete remission as final outcome occurred in 94% and 88%, respectively.

Adverse Events

A total of 32 serious adverse events occurred in 21 BrECAPP patients (42%), and 26 events occurred in 18 BrECADD patients (35%). Grade 3 or 4 hematologic adverse events occurred in 92% vs 87% of patients. Other grade 3 or 4 adverse events occurred in 17% of the BrECAPP group vs 4% of the BrECADD group. Grade 1 or 2 peripheral neuropathy occurred in 32% vs 35% of patients, with grade 3 peripheral neuropathy occurring in one BrECAPP patient. No deaths were reported.

The investigators concluded: “Both eBEACOPP variants met the co-primary efficacy endpoints. Particularly, the BrECADD regimen was associated with a more favourable toxicity profile and was, therefore, selected to challenge standard eBEACOPP for the treatment of advanced classical Hodgkin lymphoma in the phase 3 HD21 study by the German Hodgkin Study Group (NCT02661503), which aims to further reduce treatment-related morbidity.”

The study was funded by Takeda Pharmaceuticals.

Peter Borchmann, MD, of the University Hospital Cologne, is the corresponding author of The Lancet Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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