Is chemotherapy with brentuximab vedotin better than ABVD for treating advanced classical Hodgkin’s lymphoma?

This study determined the effectiveness and safety of brentuximab vedotin (Adcetris) administered with AVD (doxorubicin, vinblastine, dacarbazine) chemotherapy for stage 3 or 4 classical HL (Hodgkin’s lymphoma). The study concluded that brentuximab vedotin with AVD was more effective than ABVD (AVD plus bleomycin).

The most commonly used frontline chemotherapy regimen for advanced Hodgkin’s lymphoma (HL) is ABVD. Frontline chemotherapy for advanced HL aims to cure patients without the need for more therapy. However, up to 30% of patients have refractory (do not respond to treatment) or relapsed disease after ABVD treatment. Bleomycin, one of the components of ABVD, is associated with serious lung side effects.

Brentuximab vedotin is a monoclonal antibody. This type of treatment binds the cancer cell, leading to cancer cell death. It is not clear whether this treatment could be combined with AVD chemotherapy instead of bleomycin.

The current study investigates A+AVD, which substitutes brentuximab vendotin for bleomycin. This study involved 1334 patients with either stage 3 (483) or stage 4 disease (846). 664 patients received A+AVD and 670 patients received ABVD. The average follow-up period was 24.9 months.

At follow-up, the progression-free survival (time from treatment until disease progression) rate was 82.1% for the A+AVD group and 77.2% for the ABVD group. The A+AVD regimen decreased the risk of disease progression, death, or need for additional anticancer therapy by 23%. The overall survival (time from treatment until death from any cause) rate at 2 years was 96.6% for the A+AVD group and 94.9% for the ABVD group. The A+AVD regimen decreasing risk of death by 28%.

58% of A+AVD-treated patients experienced neutropenia (low white blood cell count) versus 45% of ABVD-treated patients. Patients over the age of 60 were more likely to experience fever related to neutropenia (37% with A+AVD; 17% with ABVD) compared to younger patients (17% with A+AVD; 6% with ABVD).

Of the A+AVD patients who received G-CSF (granulocyte colony stimulating factor) to increase white blood cell levels, 35% showed neutropenia compared to the 73% who did not receive G-CSF. 67% of A+AVD-treated patients also experienced peripheral neuropathy (numbness or pain in the hands and feet), compared to 43% of ABVD-treated patients. 

This study concluded that A+AVD is a more effective frontline treatment for advanced Hodgkin’s lymphoma (stage 3 or 4) than standard ABVD treatment.

If you have relapsed or refractory advanced Hodgkin’s lymphoma, talk to your care team about adding brentuximab vedotin to your treatment regimen. If you are 65 years or older and at risk of neutropenia, discuss adding a G-CSF.