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Brentuximab Vedotin Plus Bendamustine in Relapsed/Refractory Hodgkin Lymphoma

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Key Points

  • Response was observed in 61% of patients in phase I and in 78% in phase II.
  • Serious adverse events included neutropenia and lung infection.  

A phase I/II trial has shown that the addition of brentuximab vedotin (Adcetris) to bendamustine is active in relapsed or refractory Hodgkin lymphoma. Study findings were reported in The Lancet Oncology by O’Connor et al.

Study Details

In the study, 64 patients with Hodgkin lymphoma and 1 with anaplastic large-T-cell lymphoma (28 in phase I, 37 in phase II) were enrolled between July 2012 and May 2017. In phase I, patients received 1 dose of either 1.2 or 1.8 mg/kg of brentuximab vedotin on day 1 of a 21- day cycle plus 1 dose of bendamustine at 70, 80, or 90 mg/m² on days 1 and 2 of the cycle. In phase II, patients received the recommended phase II dose from phase I of 1.8 mg/kg of brentuximab vedotin and 90 mg/m² of bendamustine.

All patients had biopsy-proven CD30-positive tumors and had received at least one previous multiagent chemotherapy regimen. The median number of prior therapies was five in phase I and three in phase II.

Response Rates

No maximum tolerated dose of the combination was reached in phase I. Dose-limiting toxicities were observed in 3 (11%) of 28 patients, including grade 4 neutropenia in 2 patients and diffuse rash in 1 patient.

Objective response was observed in 17 patients (61%), including complete response in 5 (18%), in phase I and in 29 (78%) of 37 patients, including complete response in 16 (43%) in phase II.

Median durations of response were 4.3 months in phase I and 3.95 months in phase II.

Toxicity

The most common grade 3 or 4 adverse events in phase I were anemia (18%), decreased platelets (14%), neutropenia (11%), and infusion reaction (8%). Grade 3 or 4 adverse events in phase II consisted of neutropenia in 35% and lung infection in 14%. Adverse events led to discontinuation of treatment in two patients in phase I and two in phase II. No treatment-related deaths were observed.

The investigators concluded, “This study shows that brentuximab vedotin plus bendamustine, with a favourable safety profile, is an active salvage regimen for heavily pretreated patients with relapsed or refractory Hodgkin’s lymphoma. This salvage regimen can potentially serve as an efficacious and safe alternative to platinum-based chemotherapy before autologous stem cell transplant.”

The study was funded by Seattle Genetics, the Lymphoma Research Fund of Columbia University and National Center for Advancing Translational Sciences, and the National Institutes of Health.

Owen A. O’Connor, MD, of the Center for Lymphoid Malignancies, Columbia University Medical Center, is the corresponding author for 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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