Anas Younes, MD
Potentially practice-changing abstracts in the field of hematologic malignancies are slated to be presented at the 2017 ASH Annual Meeting, being held December 9 to 12, 2017, in Atlanta, Georgia. The topline findings include advancements in chimeric antigen receptor (CAR) T-cell therapy, immunotherapy, and combination strategies, among others.
During OncLive News Network’s
“Pre-Conference Perspectives on Hematologic Malignancies,” key opinion leaders sat down to share their insight on the pivotal and highly anticipated abstracts across hematologic malignancies—including lymphoma, leukemia, and multiple myeloma—ahead of the annual meeting, and exactly how these findings could be implemented in and affect clinical practice.
Brentuximab vedotin (Adcetris) plus doxorubicin, vinblastine, dacarbazine (A+AVD) as frontline therapy demonstrates superior modified progression-free survival versus ABVD in patients with previously untreated stage III or IV Hodgkin lymphoma (hl): the phase III ECHELON-1 study (Abstract 6)
The unblinded, open-label, multicenter, phase III trial (NCT01712490) randomized patients with stage III or IV Hodgkin lymphoma 1:1 to receive A+AVD or ABVD intravenously in the frontline setting. Modified progression-free survival was the primary endpoint of ECHELON-1. The FDA granted brentuximab vedotin a breakthrough therapy designation for the first-line treatment of patients with classical Hodgkin lymphoma based on these findings in October 2017, and a supplemental new drug application has been filed with the FDA.
“Finally, we have the data [and it] will be presented at the plenary session at ASH. This is a randomized phase III trial comparing standard ABVD with the experimental arm, which is brentuximab plus AVD—no bleomycin. More than 1300 patients were randomized. The primary endpoint is met with about 5% different in progression-free survival (PFS) at 2 years. This is news for us for Hodgkin lymphoma,” said Anas Younes, MD, professor of medicine and chief of the Lymphoma Service at Memorial Sloan Kettering Cancer Center.
“It is going to be subjected to a lot of scrutiny on subsets and analysis of patients who may have a higher benefit than others. At face value, it is progress regardless of how you cut it. The field has been stable for more than 4 decades, so this is good news that we have something beyond ABVD. I would have liked [the benefit] to be more than 5%, but it provides an option for some patients.”PET-based response after 2 cycles of brentuximab vedotin (Adcetris) in combination with AVD for first-line treatment of unfavorable early-stage Hodgkin lymphoma: first analysis of the primary endpoint of BREACH, a randomized phase II trial of LYSA-FIL-EORTC intergroup (Abstract 736)
BREACH is a randomized, multicenter phase II trial designed to evaluate the efficacy of brentuximab vedotin combined with AVD chemotherapy based on PET response after 2 cycles for previously untreated patients with unfavorable early-stage Hodgkin lymphoma (NCT02292979). Earlier results have showed that the combination demonstrated a promising efficacy with a favorable safety profile in a phase I trial for treatment-naïve patients. “The question is, ‘Can we bring brentuximab vedotin to early-stage patients?’” Younes asked. “This is trickier because early-stage patients do very well; it’s so difficult to find improvement beyond the 90% to 92% PFS with standard ABVD or plus radiation therapy. Therefore, the endpoint here was a PET-negative status and it is about 7% difference in PET negativity between ABVD versus AVD plus brentuximab. It’s too early to call. We need to look at the curves in the long term follow-up.”R-DHA-oxaliplatin before autologous stem cell transplantation prolongs PFS and OS as compared to R-DHA-carboplatin and R-DHA-cisplatin in patients with mantle cell lymphoma (MCL), a subgroup analysis of the LyMa trial (Abstract 1496)
The LyMA trial is a prospective international randomized phase III trial that investigated maintenance therapy with rituximab (Rituxan) following autologous stem cell transplantation (ASCT) in previously untreated young patients with MCL (NCT00921414). In this analysis, researchers investigated the prognostic impact on PFS and overall survival (OS) of the nature of platinum salt used in the R-DHAP regimen.