Ayad Hamdan, MD, hematologist and associate professor of medicine at Moores Cancer Center at the University of California, San Diego, discusses factors to consider when choosing between brentuximab vedotin (Adcetris), doxorubicin, vinblastine, and dacarbazine (A + AVD) versus AVD plus bleomycin (ABVD) in patients with Hodgkin lymphoma.

In the United States, ABVD is commonly used in this patient population, says Hamdan; this regimen has been used for decades. Although treatment with regimen leads to favorable results, it is associated with many toxicities are involved. A+AVD, an alternative regimen, is also available and it has shown to have similar, if not better, benefit to that of ABVD.

Hamdan says that he tends to use A+AVD in patients who have stage IV disease or an elevated International Prognostic Score (IPS), as long as they don’t have any concerning comorbidities that would put them at increased risk for neuropathy or neutropenia.

It is unknown how the National Comprehensive Cancer Network guidelines will incorporate brentuximab vedotin, says Hamdan. To date, ABVD is still considered to be the preferred regimen in this space per the guidelines; however, A+AVD is another option available in the frontline setting, concludes Hamdan.

Videos

Ayad Hamdan, MD, discusses factors to consider when choosing between brentuximab vedotin (Adcetris), doxorubicin, vinblastine, and dacarbazine versus AVD plus bleomycin in patients with Hodgkin lymphoma.

Dr. Hamdan on Choosing Among ABVD Versus A+AVD in Hodgkin Lymphoma

Ayad Hamdan, MD, hematologist and associate professor of medicine at Moores Cancer Center at the University of California, San Diego, discusses the potential use of nivolumab (Opdivo) and brentuximab vedotin (Adcetris) in patients with advanced-stage classical Hodgkin lymphoma.

Most patients with Hodgkin lymphoma are young; however, a subset of patients are over the age of 60, says Hamdan. Historically, these patients have not done very well with doxorubicin, vinblastine, dacarbazine, and vincristine and they experience increased toxicity with the regimen.

At the 2019 ASH Annual Meeting, data from a phase II trial (NCT01716806) showed encouraging responses with the combination of brentuximab vedotin and nivolumab in patients over 60 years with advanced-stage classical Hodgkin lymphoma. Of 19 evaluable patients, 18 had an objective response, 13 had a complete response, and 5 had a partial response. The median duration of response had not been reached at the time of data cutoff. Although the trial was small, the results are encouraging and suggest that the combination may serve as a treatment option for these patients, concludes Hamdan.

Dr. Hamdan on the Potential Use of Brentuximab Vedotin/Nivolumab in Hodgkin Lymphoma

Ayad Hamdan, MD, hematologist and associate professor of medicine at Moores Cancer Center at the University of California, San Diego, discusses a pilot phase I/II trial with brentuximab vedotin (Adcetris) plus chemotherapy in patients with HIV-associated Hodgkin lymphoma.

A phase II trial led by the AIDS Malignancy Consortium evaluated brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine in patients with newly diagnosed classical Hodgkin lymphoma in the setting of HIV, says Hamdan. The study showed favorable progression-free survival and overall survival with the regimen; however, there was more concern about neuropathy with brentuximab vedotin given in combination with antiretroviral medications, says Hamdan.

Despite the concern for increased neuropathy, patients with well-controlled HIV should be included in all clinical trials. HIV status should not be an exclusion criterion, concludes Hamdan.

Ayad Hamdan, MD

Articles

Dr. Hamdan on Choosing Among ABVD Versus A+AVD in Hodgkin Lymphoma

Dr. Hamdan on the Potential Use of Brentuximab Vedotin/Nivolumab in Hodgkin Lymphoma

Dr. Hamdan on Trial of Brentuximab Vedotin/Chemo in HIV-Associated Hodgkin Lymphoma