In a nutshell
This study compared ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and brentuximab vedotin (Adcedris; A) + AVD (doxorubicin, vinblastine, and dacarbazine) chemotherapy combinations to understand which is more effective long term for patients with advanced classical Hodgkin lymphoma (HL). The authors concluded that A+AVD treatment gave patients longer-lasting results but ABVD may be more suitable for patients with sensory issues.
Some background
ABVD is often used to treat patients with advanced (stage III or IV) HL. However, it is not effective for 24 to 39%. Also, it can cause serious lung side effects, particularly due to bleomycin. A + AVD is a modified version of ABVD which was shown to be more effective and safer for patients in the short term. However, it is not known if this combination continues to give better treatment results than ABVD over the long term in patients with advanced HL.
Methods & findings
1334 patients with advanced classical HL were divided into two groups. 664 patients were given A+AVD and 670 patients were given ABVD. Patients’ results were followed for an average of 37.1 months.
Patients who received A+AVD were 29.6% more likely to survive without cancer worsening over 3 years. After 3 years, 83.1% of the A+AVD group and 76% of the ABVD group had survived without cancer worsening. A+AVD increased the chances of survival without cancer worsening in patients under 60 by 31%. For patients over 60, A+AVD increased the chances of survival without cancer worsening by 21%.
Patients often undergo PET scans mid-way through a course of treatment to see how well they are responding. Those that have a significant reduction in cancer (PETneg) may reduce treatment dose. Those that still have significant amounts of cancer or obvious cancer growth (PETpos) may switch to more aggressive treatments. 85.8% of the A+AVD group and 79.5% of the ABVD group were PETneg. Patients were 31% more likely to be PETneg after A+AVD treatment than ABVD.
ABVD was more effective than A+AVD for treating sensory issues (peripheral neuropathy) in patients. Sensory issues were reduced or eliminated in 78% of patients receiving A+AVD and 83% of patients receiving ABVD. After 3 years, 25% of patients in the A+AVD group and 11% in the ABVD group had continuing sensory issues. On average, it took patients 28 weeks to recover from sensory issues in the A+AVD group and 14 weeks in the ABDV group.
The bottom line
The authors concluded that A+AVD was more effective long term than ABVD. ABVD may better suit patients with sensory problems.
The fine print
The manufacturer of brentuximab vedotin, Takeda, funded this study.
Published By :
Blood
Date :
Jan 16, 2020
