Go back to the newsletter archive

Developments in Advanced Stage HL

Latest results of large scale randomized phase III trials in advanced stage HL

One central question in Hodgkin lymphoma is the best treatment for advanced stage patients. Initial data of the company-sponsored international ECHELON-1 trial were expected with substantial interest and will be presented at ASH 2017 in detail.

At ISHL11, this and more mature data for the combination of brentuximab vedotin (BV) and AVD will be discussed on the background of other clinical trials. The very recent results of the GHSG HD18 trial demonstrated that as few as 4 cycles of BEACOPPescalated are sufficient in advanced stage patients who are PET-negative after 2 initial cycles. The ongoing HD21 trial is investigating a BV-based adapted BEACOPP variant and trials investigating anti-PD1 antibodies in this setting are ongoing.

BV in advanced stage CHL summary

  • Hodgkin Lymphoma is a highly curably malignancy
  • Long-term side effects of chemo- and radiotherapy
  • New drugs and approaches needed
  • BV registered for r/r cHL, retreatment and consolidation after HDCT
  • BV toxic (pneumonitis) in combination with ABVD
  • ECHELON-1 compared BV-AVD with ABVD
  • Primary endpoint modified PFS: Two-year modified PFS 82.1% for BV+AVD vs. 77.2% for ABVD
  • Results to be discussed

ECHELON-1 phase III trial BV+AVD vs. ABVD in advanced 1ST line chl

  • Primary endpoint modified PFS
  • Two-year modified PFS 82.1% for BV+AVD vs. 77.2% for ABVD
  • HR 0.77, p-value 0.035
  • Safety profile consistent with single agents
  • Increased febrile neutropenia and neuropathy with BV-AVD
  • Febrile neutropenia reduced with growth factors
  • Peripheral neuropathy managed by dose modifications of BV
  • More pulmonary toxicity in control arm
  • Modified PFS defined as time to progression, death or additional anticancer therapy including radiation

HD18 for PET-2-negative patients summary

  • Non-inferior PFS for PET-2-negative patients after 4 cycles of eBEACOPP compared with 8/6 cycles (primary endpoint) at a very high level (95% at 3y, 92% at 5y).
  • Significant reduction of severe acute hematological and non-hematological toxicities.
  • Elimination of HL as relevant cause of death (7/1005; i.e. 0.7%).
  • Relevant reduction of mortality for other reasons than HL.
  • Significantly superior OS with 4 cycles of eBEACOPP (99% at 3y, 98% at 5y) over 6/8 cycles.