Nivolumab-AVD Versus Brentuximab Vedotin–AVD in Older Patients With Advanced-Stage Classic Hodgkin Lymphoma Enrolled on S1826
Abstract
Older patients with classic Hodgkin lymphoma (cHL) have inferior survival compared with younger patients. We report a subset analysis of older patients (60 years and older) enrolled in the phase three S1826 trial conducted by SWOG that randomly assigned patients with newly diagnosed advanced-stage (III-IV) cHL to six cycles of nivolumab (N)–AVD or brentuximab vedotin (BV)–AVD. Of 103 enrolled patients 60 years and older, 99 were eligible. At a median follow-up of 2.1 years, the 2-year progression-free survival was 89% after N-AVD (n = 50) and 64% after BV-AVD (n = 49, HR 0.24, 95%CI 0.09-0.63, 1-sided stratified log-rank P = .001). The 2-year OS was 96% with N-AVD versus 85% with BV-AVD (HR 0.16, 95%CI 0.03-0.75 stratified 1-sided log-rank P = .005). Six cycles were delivered without dose reduction in 69% on N-AVD and 26% on BV-AVD; 55% discontinued BV, and 14% discontinued nivolumab. The nonrelapse mortality was 16% with BV-AVD and 6% with N-AVD. Despite more neutropenia with N-AVD, febrile neutropenia, sepsis, and infections were higher with BV-AVD, as was peripheral neuropathy. 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.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (23)
Sarah C. Rutherford
Division of Hematology and Medical Oncology, Weill Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
Hongli Li
Key Laboratory of Genetic Evolution and Animal Models of the Chinese Academy of Sciences, Key Laboratory of Animal Models and Human Disease Mechanisms of Yunnan Province, and Kunming Institute of Zoology and Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences
Alex F. Herrera
10Duarte Cancer Center, City of Hope Medical Center, Duarte, CA
Michael LeBlanc
2Fred Hutchison Cancer Center, Statistics, Seattle, United States
Sairah Ahmed
2Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
Kelly Davison
8McGill University, Montreal, Canada
Susan K. Parsons
Division of Hematology/Oncology, Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA
Joseph M. Unger
Public Health Sciences Division Fred Hutchinson Cancer Center Seattle Washington USA
Anamarija M. Perry
26Department of Pathology, University of Michigan, Ann Arbor, MI
Carla Casulo
18Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
Nancy L. Bartlett
2Division of Oncology, Department of Medicine, Siteman Cancer Center, St Louis, MO
Joseph M. Tuscano
University of California, Davis Medical Center, Sacramento, CA
Brian T. Hess
Medical University of South Carolina, Charleston, SC
Pallawi Torka
1memorial Sloan Kettering, NYC, United States
Pankaj Kumar
Department of Chemistry
Ryan Jacobs
13Carolinas Medical Center, Greenwood, United States
Joo Y. Song
Sharon M. Castellino
Brad Kahl
8Washington University, Division of Oncology, St. Louis, United States
John P. Leonard
Division of Hematology and Medical Oncology, Weill Department of Medicine, Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
Sonali M. Smith
3Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL
Jonathan W. Friedberg
18Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
Andrew M. Evens
Division of Blood Disorders, Rutgers Cancer Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ