{"entity":{"id":"echelon-1","kind":"trial","name":"ECHELON-1","aka":[],"tldr":"Swapping bleomycin for the CD30 ADC in first-line chemotherapy improved survival in advanced Hodgkin lymphoma, the first frontline survival gain in decades.","summary":"ECHELON-1, trial NCT01712490 sponsored by Seagen and Takeda and reported in 2017 with six-year survival in the New England Journal of Medicine in 2022, showed that swapping bleomycin for the CD30 antibody-drug conjugate brentuximab vedotin in first-line chemotherapy for advanced Hodgkin lymphoma improves survival, the first frontline survival gain in decades. It randomised 1,334 patients with stage III to IV disease to brentuximab plus AVD or ABVD, met its primary modified progression-free survival endpoint and later showed an overall survival benefit, with more neuropathy and neutropenia but less lung toxicity, leading to approval in March 2018. OnCo links it to Hodgkin lymphoma, ADCs, CD30 as a target, brentuximab vedotin, Joseph M. Connors, the bleomycin caution pairing and the ECHELON-1 and S1826 papers. Whether brentuximab keeps a frontline role after S1826 is the open question.","status":"positive","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT01712490","url":"https://clinicaltrials.gov/study/NCT01712490"}],"tags":[],"related":["lymphoma-roadmap","radar-hodgkin","hd21"],"cancers":["hodgkin-lymphoma","advanced-stage-classical-hodgkin-lymphoma"],"sections":[],"technologies":["adc"],"targets":["cd30"],"drugs":["brentuximab-vedotin","doxorubicin"],"companies":["pfizer","takeda"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":["joseph-connors"],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT01712490","phase":"3","setting":"Untreated stage III-IV classical Hodgkin lymphoma: brentuximab vedotin + AVD vs ABVD","sponsor":"Seagen / Takeda","result":"6-year OS 93.9% vs 89.4%, HR 0.59.","started":"2012-11-09","startedType":"actual","yearReported":2017,"enrolled":1334,"enrolledBasis":"registry","outcomes":[{"endpoint":"Overall survival at 6 years","unit":"%","arms":[{"name":"BV-AVD","n":664,"value":93.9},{"name":"ABVD","n":670,"value":89.4}],"hr":0.59,"ci":[0.4,0.88],"p":"0.009","source":"https://www.nejm.org/doi/full/10.1056/NEJMoa2206125"},{"endpoint":"Modified PFS at 2 years","primary":true,"unit":"%","arms":[{"name":"BV-AVD","value":82.1},{"name":"ABVD","value":77.2}],"hr":0.77,"ci":[0.6,0.98],"source":"https://www.nejm.org/doi/full/10.1056/NEJMoa1708984"}],"replication":"SWOG S1826 used BV-AVD as its control and found nivolumab-AVD superior; ECHELON-1's OS benefit stands as the comparator."},"route":"/trials/echelon-1/","neighbours":{"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"lymphoma-roadmap","kind":"roadmap","name":"Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting","route":"/roadmaps/lymphoma-roadmap/"}],"trial":[{"id":"hd21","kind":"trial","name":"GHSG HD21","route":"/trials/hd21/"},{"id":"radar-hodgkin","kind":"trial","name":"RADAR","route":"/trials/radar-hodgkin/"}],"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"}],"technology":[{"id":"adc","kind":"technology","name":"Antibody-drug conjugate (ADC)","route":"/technologies/adc/"}],"target":[{"id":"cd30","kind":"target","name":"CD30","route":"/targets/cd30/"}],"drug":[{"id":"brentuximab-vedotin","kind":"drug","name":"Brentuximab vedotin","route":"/drugs/brentuximab-vedotin/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"}],"company":[{"id":"pfizer","kind":"company","name":"Pfizer (incl. Seagen)","route":"/companies/pfizer/"},{"id":"takeda","kind":"company","name":"Takeda","route":"/companies/takeda/"}],"person":[{"id":"joseph-connors","kind":"person","name":"Joseph M. Connors","route":"/people/joseph-connors/"}],"pairing":[{"id":"bleomycin-omission-caution","kind":"pairing","name":"Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF","route":"/pairings/bleomycin-omission-caution/"}],"term":[{"id":"lymphoma-decision-beacopp-or-abvd","kind":"term","name":"Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed","route":"/terms/lymphoma-decision-beacopp-or-abvd/"}],"paper":[{"id":"paper-echelon-1-brentuximab-avd-nejm-2018","kind":"paper","name":"ECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma","route":"/key-papers/paper-echelon-1-brentuximab-avd-nejm-2018/"},{"id":"paper-swog-s1826-nivolumab-avd-nejm-2024","kind":"paper","name":"SWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults","route":"/key-papers/paper-swog-s1826-nivolumab-avd-nejm-2024/"}]}}