Post-Conference Perspectives: Peripheral T-Cell Lymphoma - Episode 4

The ECHELON-2 Trial Presented at ASH 2018


Neha Mehta-Shah, MD: We are here at the ASH meeting and were just presented the results of ECHELON-2 by Dr Steven Horwitz. ECHELON-2 was a randomized, double-blind study that was an international effort of about 500 patients with peripheral T-cell lymphomas. The majority of those patients had anaplastic large cell lymphoma. And the purpose of the study was to compare brentuximab plus CHP, so Cytoxan [cyclophosphamide], doxorubicin, and prednisone, so basically CHOP [cyclophosphamide, doxorubicin, vincristine, and prednisone] minus vincristine against CHOP itself. The reason for this was that on the earlier study that Michelle Fanale had done, it showed that brentuximab when combined with CHOP itself caused significantly more neuropathy. So the decision was made to eliminate the vincristine and replace it with brentuximab on that arm.

So patients and physicians were blinded to the randomization. About 500 patients were randomized in the study, and it was seen that the combination of brentuximab plus CHP provided a survival benefit in patients who have peripheral T-cell lymphoma across the study. This was most pronounced in the patients who have anaplastic large cell lymphoma, as would have been predicted based on their strong CD30 expression. But this is the first study to prove that we’ve improved on CHOP in peripheral T-cell lymphomas with a survival benefit. And this was a huge effort on the part of patients of physicians, and in a rare disease, I think that the investigators should applaud themselves for a tremendous effort.

In ECHELON-2, which was performed in the up-front setting, they saw that the overall response rate of the regimens was about 80%, with a 65% or so complete remission rate. Compared with CHOP historically, CHOP has historically had a 50% complete remission rate, with an 80% or so response rate in peripheral T-cell lymphomas. What was notable was that the combination of BVCHP [brentuximab vedotin and CHP] provided a survival benefit with a hazard ratio of 0.6 in this disease population.

So I think ECHELON-2 is practice changing in the world of peripheral T-cell lymphomas, particularly for those who have anaplastic large cell lymphoma. I think how BVCHP compares with CHOEP [cyclophosphamide, doxorubicin, etopside, vincristine, prednisone], which is often given for some of the other subtypes of peripheral T-cell lymphoma, and how histology-specific differences in the other subtypes of peripheral T-cell lymphoma are further being explored. The study, when it was as resulted, pooled the analysis across all histologies but…more than 75% of those patients had anaplastic large cell lymphoma. The patients who had peripheral T-cell lymphoma NOS [not otherwise specified] or angioimmunoblastic T-cell lymphoma were smaller subsets, and it’s difficult to make huge conclusions about whether BVCHP is better than CHOP for those patients. And it’s certainly not clear whether it’s better than CHOEP, which is also traditionally given. However, for patients with anaplastic large cell lymphoma, this is certainly practice changing.

Transcript Edited for Clarity