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Swapping bleomycin for the CD30 antibody-drug conjugate brentuximab vedotin modestly improved disease control in advanced Hodgkin lymphoma and, at six years, improved survival.
ECHELON-1 randomised 1334 patients with previously untreated stage III or IV classical Hodgkin lymphoma to brentuximab vedotin plus doxorubicin, vinblastine and dacarbazine (A+AVD) or standard ABVD for six cycles. The primary endpoint was modified PFS by independent review. At two years modified PFS was 82.1% versus 77.2% (hazard ratio 0.77). A+AVD caused more peripheral neuropathy (67% versus 43%) and febrile neutropenia (19% versus 8%) but eliminated bleomycin lung toxicity. The six-year update (Ansell et al., NEJM 2022) showed an overall survival benefit: 93.9% versus 89.4% (hazard ratio 0.59), the first OS improvement in front-line advanced Hodgkin lymphoma.
ECHELON-1 made a targeted antibody-drug conjugate part of first-line Hodgkin therapy and eventually showed that this saves lives, not just relapses. It set the reference arm against which nivolumab-AVD (SWOG S1826) and BrECADD (HD21) were later compared. Neuropathy is the main price and needs proactive dose modification.
Shares SWOG S1826, SWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Doxorubicin.
Shares Takeda, Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Doxorubicin.
Shares SWOG S1826, SWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults, Brentuximab vedotin, Hodgkin lymphoma.
Shares ECHELON-1, CD30, Brentuximab vedotin, Early-stage classical Hodgkin lymphoma (stage I to II).
Shares Brentuximab vedotin, Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Hodgkin lymphoma.
Shares SWOG S1826, GHSG HD21, Brentuximab vedotin, Early-stage classical Hodgkin lymphoma (stage I to II).
Shares ECHELON-1, SWOG S1826, GHSG HD21, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares SWOG S1826, SWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults, Brentuximab vedotin, Hodgkin lymphoma.