Impact of cumulative dose of brentuximab vedotin on outcomes of frontline therapy for advanced-stage Hodgkin lymphoma

• Type of Material: Article
• Authors: Raphael E. Steiner, University of Texas MD Anderson Cancer Center; Steven R Hwang, Mayo Clinic Comprehensive Cancer Center, Rochester, MN; Arushi Khurana, Mayo Clinic Comprehensive Cancer Center, Rochester, MN; Thomas M Habermann, Mayo Clinic Comprehensive Cancer Center, Rochester, MN; Narendranath Epperla, The Ohio State University; Kaitlin Annunzio, The Ohio State University James Cancer Hospital and Solove Research Institute; Pamela Allen, Emory University; Katelin Baird, Emory University; Darina Paulino, Emory University; Steven M Bair, University of Colorado Anschutz Medical Campus; Manali Kamdar, University of Colorado Anschutz Medical Campus; Sheeba Ba Aqeel, Roswell Park Comprehensive Cancer Center; Pallawi Torka, Roswell Park Comprehensive Cancer Center; Ryan Lynch, University of Washington; Stephen Smith, University of Washington; Lei Feng, University of Texas; Mansoor Noorani, University of Texas; Sairah Ahmed, University of Texas; Ranjit Nair, University of Texas; Francisco Vega, University of Texas; Susan Wu, University of Texas; Penny Fang, University of Texas; Chelsea C Pinnix, University of Texas; Jillian R Gunther, University of Texas; Bouthaina S Dabaja, University of Texas; Hun J Lee, University of Texas; Juan Pablo Alderuccio, University of Miami; Izidore S Lossos, University of Miami; Kevin David, Rutgers Cancer Institute of New Jersey; Andrew M Evens, Rutgers Cancer Institute of New Jersey; Karan Pandya, Rutgers Cancer Institute of New Jersey
• Language: English
• Date: 2023-12-26
• Publisher: American Society of Hematology
• Publication Version: Final Published Version
• Copyright Statement: © 2023 by The American Society of Hematology
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://ashpublications.org/bloodadvances/article/7/24/7485/497552/Impact-of-cumulative-dose-of-brentuximab-vedotin
• Title of Journal or Parent Work: Blood Advances
• Volume: 7
• Issue: 24
• Start Page: 7485
• End Page: 7493
• Grant/Funding Information: This work was supported by Lymphoma Specialized Programs of Research Excellence grant P50 CA97274.
• Keywords: Frontline therapy; Hodgkin lymphoma; Cumulative dose; Brentuximab vedotin
• Research Categories: Health Sciences, Oncology

Abstract

In the pivotal study ECHELON-1, brentuximab vedotin (BV), doxorubicin, vinblastine, and dacarbazine (A + AVD) demonstrated superior efficacy compared with bleomycin + AVD for the treatment of advanced-stage classic Hodgkin lymphoma (cHL). However, there are minimal available data regarding the frequency of dose reductions or omission of BV during curative therapy and the potential impact on patient outcomes. In a real-world analysis, we retrospectively reviewed the characteristics and outcomes of 179 patients with stage III or IV cHL treated with frontline A + AVD from January 2010 to April 2022. Treatment consisted of up to 1.2 mg/kg of BV and standard dose AVD IV on days 1 and 15 of each 28-day cycle for up to 6 cycles. At the time of treatment, the median patient age was 37 years, and a high-risk International Prognostic Score was observed in 46% of patients. Overall, 91% of patients received 6 cycles of AVD; 55% of patients did not receive the intended cumulative dose of BV (CDB); 28% of patients received two-thirds or less than the planned CDB. At a median follow-up time of 27.4 months (95% confidence interval [CI], 24.8-29), the median progression-free survival (PFS) was not reached, and the 12-month PFS was 90.3% (95% CI, 85.9-95.0). The impact of CDB on PFS was not significant (P = .15), nor was high CDB significantly associated with increased adverse events. In real-world experience, A + AVD is a highly effective treatment for patients with advanced-stage cHL, including for patients with prominent dose reductions of BV.