In North America, the standard front-line treatment for advanced Hodgkin lymphoma is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), but this regimen is not effective in all patient subsets. To improve upon the regimen’s efficacy, researchers are evaluating new combinations, said Stephen M. Ansell, MD, PhD, of The Mayo Clinic, Rochester, Minnesota, who described novel approaches in an interview with The ASCO Post.
“Improved combinations should benefit not only young, fit patients but also the elderly or sicker patients with Hodgkin lymphoma,” he said.
Novel Agents
The most promising strategy to improve upon ABVD comes in the form of novel agents, especially brentuximab vedotin (Adcetris), rituximab (Rituxan), and lenalidomide (Revlimid), recent studies suggest.
According to Dr. Ansell, the strategy attracting the most interest is the use of brentuximab, either in combination with ABVD or substituting brentuximab for bleomycin in the regimen. At the recent 9th International Symposium on Hodgkin Lymphoma, Dr. Ansell discussed previously reported data showing that this strategy achieved a 95% complete response rate (see accompanying report).1
Rituximab added to ABVD also looked promising in a trial of 78 patients, where the complete response rate was 93%, and the 5-year event-free survival rate was 83%.2 Furthermore, the 5-year event-free survival rate for patients with an International Prognostic Score (IPS) of 0 to 2 was 88%, and for those with an IPS > 2, it was 73%. The most frequent treatment-related grade 3 or 4 adverse events were neutropenia (23%), fatigue (9%), and nausea (8%).
The results suggest that the addition of rituximab to ABVD is safe and has promising clinical activity in patients with advanced-stage Hodgkin lymphoma.
Further Investigations
Another strategy being evaluated by the German Hodgkin Study Group (GHSG) is the addition of lenalidomide to ABVD. In a recent phase I/II study, the GHSG evaluated the benefit and safety of four to eight cycles of AVD plus lenalidomide (5–35 mg/d), followed by radiotherapy, in 25 patients aged 60 to 76 years.3
“The data looked very encouraging, and the regimen was well tolerated, so more elderly patients should be able to receive it,” Dr. Ansell said. ■
References
1. Ansell SM, Connors JM, Park SI, et al: Front-line therapy with brentuximab vedotin combined with ABVD or AVD in patients with newly diagnosed advanced stage Hodgkin lymphoma. 9th International Symposium on Hodgkin Lymphoma, Cologne, Germany. Abstract P005. Presented October 15, 2013.
2. Younes A, Oki Y, McLaughlin P, et al: Phase 2 study of rituximab plus ABVD in patients with newly diagnosed classical Hodgkin lymphoma. Blood 119:4123-4128, 2012.
3. Böll B, Plutschow A, Fuchs M, et al: GHSH phase I/II trial of AVD-Rev (Adriamycin, vinblastine, dacarbazine and lenalidomide) for older Hodgkin lymphoma patients. 9th International Symposium on Hodgkin Lymphoma. Abstract T076. Presented October 14, 2013.
