Dr. Kaplan on the Phase III ECHELON-1 Trial in Hodgkin Lymphoma

Lawrence D. Kaplan, MD, clinical professor of medicine, director, Adult Lymphoma Program, Division of Hematology-Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the results of the phase III ECHELON-1 trial in Hodgkin lymphoma.

In the phase III trial, patients with advanced Hodgkin lymphoma were randomized to receive either brentuximab vedotin (Adcetris) combined with doxorubicin, vinblastine, and dacarbazine (A+AVD) or standard doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). The initial trial results were presented at the 2017 ASH Annual Meeting, in which there was a 5% improvement in median progression-free survival (mPFS) favoring the brentuximab vedotin arm, says Kaplan. The North American cohort represented approximately half of the patients in the entire study.

The subgroup analysis of the North American cohort was a planned analysis, explains Kaplan. The difference in mPFS between arms was about 10%. However, the study has been subject to criticism as mPFS is not a standard endpoint that has ever been validated, adds Kaplan. Moreover, the study has not yet shown a benefit in overall survival. Considering the substantial cost differential between regimens, Kaplan advises the use of ABVD in practice. Although pulmonary toxicity was seen in the ABVD arm, it is no longer necessary to do 6 cycles of the therapy.