In a subset analysis from the phase III SWOG S1826 trial reported in the Journal of Clinical Oncology, Rutherford et al compared the survival outcomes of nivolumab plus AVD (doxorubicin, vinblastine, dacarbazine; N-AVD) vs brentuximab vedotin plus AVD (BV-AVD) in patients with advanced-stage classical Hodgkin lymphoma (cHL) aged ≥ 60 years.
Study Details
In the trial, 994 patients with newly diagnosed advanced-stage (III or IV) cHL were randomly assigned between July 2019 and October 2022 to six cycles of N-AVD or BV-AVD. Of these, 99 patients were aged ≥ 60 years and had been randomly assigned to N-AVD (n = 50) or BV-AVD (n = 49).
Key Findings
Median follow-up was 2.1 years. Six cycles were administered without dose reduction in 69% of patients in the N-AVD group and 26% of patients in the BV-AVD group; discontinuation of N occurred in 14% of patients and discontinuation of BV occurred in 55%.
Progression-free survival at 2 years was 89% in the N-AVD group vs 64% in the BV-AVD group (hazard ratio [HR] = 0.24, 95% confidence interval [CI] = 0.09–0.63, P = .001). Overall survival at 2 years was 96% in the N-AVD group vs 85% in the BV-AVD group (HR = 0.16, 95% CI = 0.03–0.75, P = .005). Nonrelapse mortality was 6% with N-AVD and 16% with BV-AVD.
Any-grade adverse events were more frequent in the BV-AVD group vs the N-AVD group, although any-grade neutropenia was more common in the latter (53.0% vs 33.9%); however, grade ≥ 3 febrile neutropenia (12.2% vs 19.1%) and grade ≥ 3 sepsis (6.1% vs 21.3%) were more common with BV-AVD. Grade ≥ 3 anemia, thrombocytopenia, and gastrointestinal adverse events were more frequent with BV-AVD, as was any-grade peripheral sensory neuropathy (32.7% [10.2% grade ≥ 2] vs 68.1% [51.1% grade ≥ 2]). Key patient-reported outcomes of sensory neuropathy, diarrhea, myalgia, and arthralgia occurred more frequently with BV-AVD.
The investigators concluded: “Patient-reported outcomes of key adverse events confirmed the improved toxicity profile of N-AVD over BV-AVD. N-AVD was better tolerated and more effective than BV-AVD and is therefore a new standard of care for older patients with advanced-stage cHL fit for anthracycline-based combination therapy.”
Sarah C. Rutherford, MD, of Weill Cornell Medicine, New York, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Cancer Institute and Bristol Myers Squibb. For full disclosures of all study authors, visit ascopubs.org.
