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Swapping bleomycin for the CD30 ADC in first-line chemotherapy improved survival in advanced Hodgkin lymphoma, the first frontline survival gain in decades.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,334 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 6 years | BV-AVD | 664 | 93.9% | 0.59 (0.4 to 0.88) | 0.009 | link |
| ABVD | 670 | 89.4% | ||||
| Modified PFS at 2 yearsprimary | BV-AVD | - | 82.1% | 0.77 (0.6 to 0.98) | - | link |
| ABVD | - | 77.2% |
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.
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 Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed, ECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma, SWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults, Brentuximab vedotin.
Shares Takeda, Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Doxorubicin.
Shares GHSG HD21, Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV), 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.
Shares Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF, Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed, Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF, Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed, GHSG HD21, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares RADAR, CD30, Brentuximab vedotin, 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.
Shares CD30, Brentuximab vedotin, Pfizer (incl. Seagen), 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.
Shares 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, Hodgkin lymphoma.