ASCO: Novel treatment for Hodgkin lymphoma significantly improves progression-free survival

Investigators report that BrECADD, a novel therapy combination, treats classic Hodgkin lymphoma more effectively and with fewer side effects than BEACOPP, the standard intensive therapy regimen.

BrECADD includes brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone while BEACOPP includes bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone.

The research was presented at the American Society of Clinical Oncology (ASCO) Annual Meeting on July 1, 2024.

“Classic Hodgkin lymphoma can be cured with chemotherapy in most patients. However, the cure is accompanied by the cost of acute, chronic, and sometimes long-lasting severe side effects. With this new BrECADD regimen, we aimed to improve the balance of risks and benefits of effective systemic treatment,” said lead study author Peter Borchmann, MD, University Hospital of Cologne, and Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf and German Hodgkin Study Group.

In the GHSG HD21 trial, the investigators randomized 742 subjects to receive BrECADD and 740 to receive BEACOPP. Patients were an average age of 31 years.

The researchers used positron-emission tomography (PET) to determine whether to give subjects four or six cycles of treatment. If the cancer responded robustly to the treatment (relatively cancer-free PET scans after two cycles of treatment) then fewer ensuing cycles of treatment would be given. If the cancer was not responsive to treatment, then a greater number of cycles would be given.

At 4 years follow-up, 430 (64%) of the subjects who had received BrECADD and 430 patients (64%) of those who had received BEACOPP were eligible for a reduction in treatment cycles. Progression-free survival was 94.3% for BrECADD and 90.9% for BEACOPP. Overall survival was 98.5% for BrECADD and 98.2% for BEACOPP.

Of most significance was the finding that BrECADD subjects had achieved a 34% lower risk of disease progression than BEACOPP subjects.

Severe blood-related side effects appeared in 31% of BrECADD subjects and 52% of BEACOPP subjects. BrECADD subjects required fewer transfusions of red blood cells and platelets.

The authors concluded, “BrECADD is significantly more effective than BEACOPP and is associated with an unprecedentedly high 4-year PFS [progression-free survival], reducing the risk of progression, relapse or death by a third. Together with an abbreviated treatment duration of only 3 months for the majority of patients and a favorable tolerability, treatment with PET2-individualized BrECADD sets a new benchmark for the treatment of adult patients with AS-cHL (advanced-stage classical Hodgkin lymphoma).