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Adding a PD-1 antibody to chemotherapy beat the brentuximab-based standard, with 92% of patients progression-free at two years and less nerve damage.
S1826 was a phase 3 trial run jointly by adult and paediatric cooperative groups, randomising 994 patients aged 12 and over with newly diagnosed stage III or IV classical Hodgkin lymphoma to nivolumab plus AVD (N-AVD) or brentuximab vedotin plus AVD (BV-AVD) for six cycles. Radiotherapy was discouraged and given to under 1%. The primary endpoint was PFS. At two years PFS was 92% versus 83% (hazard ratio 0.45), with benefit across ages including patients over 60. N-AVD caused less peripheral neuropathy and fewer treatment discontinuations, while immune-related events (mainly thyroid dysfunction and rash) were mostly low grade.
S1826 moved checkpoint blockade into first-line Hodgkin lymphoma and made N-AVD a preferred regimen for advanced disease in patients from adolescence to older age, while removing radiotherapy for most. It also showed the value of a single trial spanning paediatric and adult groups. Longer follow-up is needed for overall survival and late immune effects in young patients.
Shares ECHELON-1, ECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma, Brentuximab vedotin, Hodgkin lymphoma.
Shares ECHELON-1, SWOG S1826, GHSG HD21, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares SWOG S1826, GHSG HD21, Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares AHOD2131 (COG / NCTN), Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Hodgkin lymphoma.
Shares ECHELON-1, Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Hodgkin lymphoma.
Shares Immune-related adverse events (irAEs), Progression-free survival (PFS), Bristol Myers Squibb, Nivolumab.
Shares Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Doxorubicin, Survivorship and late effects are neglected.
Shares GHSG HD21, Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Doxorubicin.