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ECHELON-2 was the first trial in decades to improve on CHOP chemotherapy for T-cell lymphoma: swapping vincristine for the antibody-drug conjugate brentuximab vedotin helped patients live longer, especially those with anaplastic large cell lymphoma.
ECHELON-2 randomised 452 patients with previously untreated CD30-positive peripheral T-cell lymphoma, about 70 percent of them with systemic anaplastic large cell lymphoma, to six to eight cycles of brentuximab vedotin plus cyclophosphamide, doxorubicin and prednisone (A+CHP) or to standard CHOP. The primary endpoint was progression-free survival by independent review.
A+CHP lengthened progression-free survival and, unusually for a lymphoma trial, overall survival, with a similar rate of peripheral neuropathy to CHOP. It was approved in the United States in November 2018 for CD30-expressing peripheral T-cell lymphomas and is the standard front-line regimen for anaplastic large cell lymphoma; its benefit in the other CD30-positive histologies is less certain because they were a minority of the trial.
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.
452 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival (blinded independent central review)primary | A+CHP (brentuximab vedotin, cyclophosphamide, doxorubicin, prednisone) | 226 | 48.2 months | 0.71 (0.54 to 0.93) | 0.0110 | link |
| CHOP | 226 | 20.8 months | ||||
| Febrile neutropenia | A+CHP (brentuximab vedotin, cyclophosphamide, doxorubicin, prednisone) | 226 | 18% | - | - | link |
| CHOP | 226 | 15% | ||||
| Peripheral neuropathy | A+CHP (brentuximab vedotin, cyclophosphamide, doxorubicin, prednisone) | 226 | 52% | - | - | link |
| CHOP | 226 | 55% |
Shares Randomised evidence for the T-cell lymphomas, including the ones that are not in Europe or North America, Takeda, Brentuximab vedotin, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma) and the tag subtype-trials.
Shares Vincristine, Doxorubicin and the tag subtype-trials.
Shares 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, Cyclophosphamide, Non-Hodgkin lymphoma (all types) and the tag subtype-trials.
Shares Vincristine, Cyclophosphamide and the tag subtype-trials.
Shares 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, Non-Hodgkin lymphoma (all types) and the tag subtype-trials.
Shares Doxorubicin, Cyclophosphamide and the tag subtype-trials.
Shares Vincristine and the tag subtype-trials.
Shares Pfizer (incl. Seagen) and the tag subtype-trials.