Nivolumab+AVD in Advanced-Stage Classic Hodgkin’s Lymphoma
This is not only safer (less toxicity with nivo) but reduced disease progression or death by 52%.
Nivolumab-AVD Versus Brentuximab Vedotin–AVD in Older Patients With Advanced-Stage Classic Hodgkin Lymphoma Enrolled on S1826
Author(s): Sarah C. Rutherford, MD1; Hongli Li, MS2; Alex F. Herrera, MD3; Michael LeBlanc, PhD2; Sairah Ahmed, MD4; Kelly Davison, MD, PhD5; Susan K. Parsons, MD, MRCP6; Joseph M. Unger, PhD, MS2; Anamarija M. Perry, MD7; Carla Casulo, MD8; Nancy L. Bartlett, MD9; Joseph M. Tuscano, MD10; Brian T. Hess, MD11; Pallawi Torka, MD12; Pankaj Kumar, MD13; Ryan Jacobs, MD14; Joo Y. Song, MD3; Sharon M. Castellino, MD, MSc15; Brad Kahl, MD9; John P. Leonard, MD1; Sonali M. Smith, MD16; Jonathan W. Friedberg, MD MMSc8; Andrew M. Evens, DO, MBA, MMSc17;
Source: doi.org/10.1200/JCO-25-00204
Dr. Anjan Patel's Thoughts
The S1826 phase III trial evaluated N-AVD vs BV-AVD in patients ≥60 years with advanced-stage cHL, showing a significant improvement in 2-year PFS (89% vs 64%) and OS (96% vs 85%) with N-AVD. N-AVD was better tolerated, with fewer discontinuations (14% vs 55%), lower nonrelapse mortality (6% vs 16%), and less peripheral neuropathy, despite higher rates of neutropenia. Patient-reported outcomes confirmed a more favorable toxicity profile for N-AVD, and notably, no EBV+ patients on N-AVD progressed, compared to 7/11 on BV-AVD. Bottom line: Today, N-AVD is essentially the SOC for most everyone with cHL..
ABSTRACT
AbstractOlder patients with classic Hodgkin lymphoma (cHL) have inferior survival compared with younger patients. We report a subset analysis of older patients (60 years and older) enrolled in the phase three S1826 trial conducted by SWOG that randomly assigned patients with newly diagnosed advanced-stage (III-IV) cHL to six cycles of nivolumab (N)–AVD or brentuximab vedotin (BV)–AVD. Of 103 enrolled patients 60 years and older, 99 were eligible. a median follow-up of 2.1 years, the 2-year progression-free survival was 89% after N-AVD (n = 50) and 64% after BV-AVD (n = 49, HR 0.24, 95%CI 0.09-0.63, 1-sided stratified log-rank P = .001). The 2-year OS was 96% with N-AVD versus 85% with BV-AVD (HR 0.16, 95%CI 0.03-0.75 stratified 1-sided log-rank P = .005). Six cycles were delivered without dose reduction in 69% on N-AVD and 26% on BV-AVD; 55% discontinued BV, and 14% discontinued nivolumab. The nonrelapse mortality was 16% with BV-AVD and 6% with N-AVD. Despite more neutropenia with N-AVD, febrile neutropenia, sepsis, and infections were higher with BV-AVD, as was peripheral neuropathy. Patient-reported outcomes of key adverse events confirmed the improved toxicity profile of N-AVD over BV-AVD. N-AVD was better tolerated and more effective than BV-AVD and is therefore a new standard of care for older patients with advanced-stage cHL fit for anthracycline-based combination therapy.
Author Affiliations
1Weill Cornell Medicine, New York, NY; 2Fred Hutchinson Cancer Center, Seattle, WA; 3City of Hope Comprehensive Cancer Center, Duarte, CA; 4The University of Texas MD Anderson Cancer Center, Houston, TX; 5Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada; 6Tufts Medical Center, Boston, MA; 7University of Michigan, Ann Arbor, MI; 8Wilmot Cancer Center, University of Rochester, Rochester, NY; 9Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO; 10University of California, Davis Medical Center, Sacramento, CA; 11Medical University of South Carolina, Charleston, SC; 12Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; 13Illinois CancerCare, Bloomington, IL; 14Atrium Health Levine Cancer Institute, Charlotte, NC; 15Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Atlanta, GA; 16Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL; 17Division of Blood Disorders, Rutgers Cancer Institute New Jersey, New Brunswick, NJRelated Articles
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Concurrent pembrolizumab with AVD for untreated classic Hodgkin lymphoma
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