Managing patients with limited-stage Hodgkin lymphoma by brentuximab vedotin based therapy

The study evaluated if brentuximab-vedotin (BV; Adcetris) consolidation therapy can reduce the use of radiation therapy (RT) in patients with limited-stage (LS) Hodgkin lymphoma (HL). The authors found that BV consolidation achieved good outcomes in such patients when given after ABVD therapy.

HL is a cancer of the lymphatic system with abnormal B-lymphocytes in blood. First two stages of HL are called LS. HL is commonly treated with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy followed by RT. However, RT causes long-term side effects, a higher risk of other cancers, and death.

BV is an antibody-based therapy. It is approved for treating later HL stages with AVD (doxorubicin, vinblastine, and dacarbazine). However, the outcomes of BV after ABVD, while avoiding RT in patients with LS-HL are unknown.

The study included 39 patients with LS-HL. All patients received 2-6 cycles of ABVD followed by 6 cycles of BV consolidation. Consolidation treatment aims to kill any remaining cancer cells left after initial treatment while reduces the risk of cancer returning. Patients were followed up for 47 months on average.

After ABVD treatment, 4 patients still harbored cancer cells. All of them became cancer-free after BV therapy. Overall, 97% of patients were estimated to survive for 3 years. Progression-free survival (PFS) means how long patients survive without cancer’s relapse. The estimated 3-year PFS rate was 92%.

A total of 37 patients achieved and maintained complete remission (CR) until the end of study. CR defines the absence of all clinical cancer symptoms. None of these patients required RT. THE estimated PFS rate for 3-years was 100% in this group. Overall, BV was safe and tolerated among patients. BV doses were needed to be reduced in 4 patients.

The study concluded that BV consolidation after ABVD therapy was beneficial in patients with LS-HL. Early treatment with BV may reduce the use of RT in such patients.

This study included a very small patient population. Outcomes of BV were also not compared to any control treatment. Further studies are needed. This study was supported by Seattle Genetics, the manufacturer of BV.