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Updated ECHELON-1 Findings Demonstrate Potential Toxicities of Brentuximab Vedotin Combo in cHL

David J. Straus, MD
Published Online:12:31 PM, Wed June 19, 2019

David J. Straus, MD, a medical oncologist in the Lymphoma Service at Memorial Sloan Kettering Cancer Center, discusses the toxicities associated with the combination of brentuximab vedotin (Adcetris) plus doxorubicin, vinblastine, and dacarbazine (A+AVD) in patients with stage III/IV classical Hodgkin lymphoma (cHL), according to data from the 3-year update of the ECHELON-1 trial presented at the 2019 ASCO Annual Meeting. This regimen was approved by the FDA previously for the treatment of newly diagnosed patients with stage III/IV Hodgkin lymphoma, and new safety findings still support this indication.

Patients were randomized in this phase III trial to receive either doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy or brentuximab vedotin plus A+AVD. In the combination arm, patients had more febrile neutropenia as the regimen is more myelosuppressive, but without the risk of bleomycin-associated toxicities. With the use of prophylactic growth factor support, the rate of febrile neutropenia is reduced to around 10%, which is about the same as with the R-CHOP regimen that is commonly used in non-Hodgkin lymphoma, says Straus.

Straus adds that a major toxicity concern is sensory peripheral neuropathy; a higher incidence rate was noted in the combination arm as compared to the ABVD-alone arm. However, in both arms, there was either improvement or disappearance of peripheral neuropathy over time. After 3-year follow-up, 17% of patients in the brentuximab vedotin/A-AVD arm still had residual grade I/II peripheral neuropathy versus 5% in the chemotherapy arm.
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