Hodgkin Lymphoma: Using Brentuximab Vedotin Frontline
Insights From: Stephen M. Ansell, MD, PhD, Mayo Clinic; Radhakrishnan Ramchandren, MD, Wayne State University School of Medicine
Radhakrishnan Ramchandren, MD: The ECHELON-1 study is a phase III randomized clinical study comparing standard ABVD with brentuximab vedotin plus AVD in classical Hodgkin lymphoma. This study is one of the largest studies that has been performed in America and Europe in Hodgkin lymphoma. Importantly, it has shown a benefit in terms of progression-free survival for patients who receive brentuximab vedotin/AVD, compared to ABVD.
This benefit was approximately 5%. It’s important to note that patients who received ABVD, by and large, did very well. If brentuximab vedotin is approved by the FDA in combination with AVD, I think it will be very critical, in the future, to identify patients who are most likely to benefit.
It’s difficult to recommend a therapy with a slightly higher toxicity profile, particularly when you consider neutropenia and the cost of therapy to all patients with classical Hodgkin lymphoma, when the overall outcome with ABVD has been very good.
That being said, this study showed no subset population that benefited from brentuximab vedotin over another subset population. So, in the end, ultimately, this is a patient-by-patient decision. Certainly, the side effect profiles must be considered. For example, patients with neuropathy who are entering treatment, or patients who are at risk for febrile neutropenia may need to weigh the risks and benefits of brentuximab vedotin in this setting, as opposed to traditional ABVD.
Additionally, risk-adapted therapies continue to evolve and may be considered for patients with ABVD as well. This may allow physicians another option in the frontline therapy of classical Hodgkin lymphoma. Currently, I would consider brentuximab vedotin/AVD in this population of patients with advanced stage disease, but only after a third discussion that includes both the risks and the benefits of all therapies for these patients.