The immune checkpoint inhibitor nivolumab plus chemotherapy significantly reduced the risk of disease progression and disease-related death compared with standard treatment with the CD30-targeted drug brentuximab vedotin plus chemotherapy in pediatric and adult patients with previously untreated stage III or IV Hodgkin lymphoma. The results of the federally funded SWOG S1826 clinical trial were presented by Alex Francisco Herrera, MD, and colleagues at the 2023 ASCO Annual Meeting (Abstract LBA4).
Alex Francisco Herrera, MD
About SWOG S1826
SWOG S1826 was a randomized, phase III trial that study enrolled 976 people aged 12 years or older who had not received previous treatment for advanced Hodgkin lymphoma. Patients were randomly assigned to receive either nivolumab, a PD-1 immune checkpoint inhibitor, or brentuximab vedotin, an antibody-drug conjugate directed against tumor necrosis factor receptor CD30.
Key Findings
With a median follow-up of 12.1 months, there was a 52% reduction in risk of disease-related death with nivolumab vs brentuximab vedotin. The 1-year progression-free survival rate with nivolumab was 94% vs 86% with brentuximab vedotin. There were 11 deaths (7 due to adverse events) with brentuximab vedotin vs 4 with nivolumab (3 due to adverse events).
Treatment with nivolumab in this trial had limited adverse events due to the immunotherapy alone; the most common side effects were typical of combination chemotherapies, including low blood cell counts and gastrointestinal toxicities, such as nausea. Immune-related adverse events were infrequent.
“Traditionally, adults and children with advanced Hodgkin lymphoma in the U.S. have been treated with different chemotherapy regimens, and the majority of children also receive radiation treatment, whereas the use of radiation has been uncommon in adult patients,” said lead author Dr. Herrera, a hematologist-oncologist at City of Hope. “As part of the design and planning of our trial, adult and pediatric cooperative groups met and arrived at a consensus on both the control and experimental regimens, with the goal of harmonizing the treatment of Hodgkin lymphoma across all ages, which is a truly unique outcome.”
Next Steps
Longer follow-up is needed to assess overall survival and other patient-related outcomes such as quality of life.
ASCO Perspective
“This trial was an unprecedented effort across all North American clinical trial cooperative groups to improve the cure rate in advanced-stage Hodgkin lymphoma and harmonize treatment approaches between pediatric and adult patients. The collaborations across adult and pediatric groups helped pave the way for a new standard of care that is better tolerated and results in a higher proportion of patients with durable remissions,” said ASCO expert Oreofe Odejide, MD.
Disclosure: Funding was provided by the National Cancer Institute of the National Institutes of Health. For full disclosures of the study authors, visit coi.asco.org.
