Effective and tolerable treatments are needed for older patients with classical Hodgkin lymphoma (cHL). We report results for older patients with cHL treated in the large phase III ECHELON-1 study of frontline brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A+AVD) versus doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Modified progression-free survival (PFS) per independent review facility (IRF) for older versus younger patients (aged ≥60 versus <60 years) was a prespecified subgroup analysis; as the ECHELON-1 study was not powered for these analyses, reported P-values are descriptive. Of 1,334 enrolled patients, 186 (14%) were aged ≥60 years (A+AVD: n=84, ABVD: n=102); results below refer to this age group. Modified PFS per IRF was similar between arms at 24 months (A+AVD: 70.3% [95% confidence interval (CI): 58.4–79.4], ABVD: 71.4% [95% CI: 60.5–79.8], hazard ratio (HR): 1.00 [95% CI: 0.58–1.72], P=0.993). After a median follow-up of 60.9 months, 5-year PFS per investigator was 67.1% with A+AVD versus 61.6% with ABVD (HR: 0.820 [95% CI: 0.494–1.362], P=0.443). Comparing A+AVD versus ABVD, grade 3/4 peripheral neuropathy occurred in 18% versus 3%; anygrade febrile neutropenia in 37% versus 17%; and any-grade pulmonary toxicity in 2% versus 13%, respectively, with three (3%) pulmonary toxicity-related deaths with ABVD (none with A+AVD). Altogether, A+AVD showed overall similar efficacy to ABVD with survival rates in both arms comparing favorably to prior series in older patients with advanced-stage cHL. Furthermore, A+AVD was associated with higher neuropathy and neutropenia rates, but lower rates of pulmonary-related toxicity than ABVD.
Figures & Tables
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.