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A new brentuximab-based intensive regimen matched Europe's most effective (and most toxic) chemotherapy with far fewer side effects.
GHSG HD21, trial NCT02661503 sponsored by the German Hodgkin Study Group and published in the Lancet in 2024, showed that a new brentuximab-based intensive regimen, BrECADD, matched and then beat escalated BEACOPP, Europe's most effective and most toxic chemotherapy for advanced Hodgkin lymphoma, with far fewer side effects. It randomised about 1,500 patients aged 18 to 60 to PET-guided BrECADD or escalated BEACOPP for four to six cycles, met non-inferiority and then superiority on progression-free survival at four and five years, and reduced treatment-related morbidity while preserving fertility markers. OnCo links it to Hodgkin lymphoma, PET-adapted therapy, brentuximab vedotin, Peter Borchmann, the German Hodgkin Study Group and the ECHELON-1 and S1826 papers. Whether an intensive regimen is still needed when nivolumab-AVD has performed so well 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.
1,500 enrolled.
For fit younger patients treated in the intensive German tradition, BrECADD replaces escalated BEACOPP; how it compares with nivolumab-AVD from S1826 is the open question.
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.
The basis for four cycles of escalated BEACOPP as the German standard when the interim scan is negative, and the reason rituximab was abandoned as an addition to that regimen. The authors recommend the scan-guided strategy for all patients with advanced-stage disease.
Shares Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed, PET-adapted (response-adapted) therapy, British and American lymphoma practice: where they differ, and why, AHL2011.
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, British and American lymphoma practice: where they differ, and why, SWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults.
Shares Fertility before lymphoma treatment: what to ask for, and when, GHSG HD10, AHL2011, PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group.
Shares German Hodgkin Study Group, GHSG HD10, PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group, GHSG HD18.
Shares ECHELON-1, PET-adapted (response-adapted) therapy, Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares PET-adapted (response-adapted) therapy, AHL2011, PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group, GHSG HD18.
Shares ECHELON-1, ECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma, Brentuximab vedotin, Hodgkin lymphoma.
Shares Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed, Fertility before lymphoma treatment: what to ask for, and when, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Hodgkin lymphoma.