Dr Thanos Zomas: Hodgkin Lymphoma Outcomes Improve With Targeted Treatment

On day 2 of the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Thanos Zomas, MD, global medical lead, Lymphoma and Leukemia, and global medical lead, Adcetris Program, Takeda Oncology, discusses updated results of the ECHELON-1 study, which show significantly improved mortality risk and 6-year survival rate with the addition of brentuximab vedotin to first-line chemotherapy.

Transcript

Can you discuss the unmet need for patients with newly diagnosed classical Hodgkin lymphoma?

Hodgkin’s lymphoma is a relatively rare form of lymphoma. There are more than 100 different types of lymphoma, and Hodgkin’s lymphoma is one of them. It’s been considered, thankfully, a very curable disease, but despite this, there is a percentage—perhaps in the region of 20% to 30%—of these patients who unfortunately relapse after their initial therapy. And so they require additional treatment. Most of the times this treatment is more intensive and repetitive. And so is there is an unmet medical need there that requires better treatments in the beginning.

Why is finding optimal first-line treatment so important with these patients?

The majority of these patients are relatively young. The average age of Hodgkin’s lymphoma patients is between 35 and 40 years—although we’ve seen patients at a much earlier age and very late. They are in the most productive phase of their life, so it’s very important to cure as many as possible with the first round of chemotherapy in order to avoid additional treatment, which is associated with a very negative impact on their quality of life, as well as some very unpleasant secondary side effects, including secondary malignancies, fertility problems, and cardiovascular side effects.

Can you discuss the design and end points of ECHELON-1?

So the ECHELON-1 study was really an international study that included many countries across the world. It was a phase 3 fully randomized study that compared the standard of care of therapy in frontline treatment, which is called ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, and dacarbazine), with a new regimen called A+AVD (brentuximab vedotin [Adcetris], doxorubicin, vinblastine, and dacarbazine), and which basically substituted one of the weakest drugs of the ABVD regimen, the bleomycin, with the anti-CD30–targeted agent called brentuximab vedotin.

This trial started enrolling patients in 2012 and completed its enrollment in 2016. It created a lot of excitement because the disease is relatively rare. So the fact that ECHELON-1 included a very large number of patients, around 1400 patients, created a lot of expectations and hopes.

What do the 6-year results of ECHELON-1 show?

In this Congress for the first time, we report the first official overall survival analysis of the ECHELON-1 study, which shows a fairly significant survival advantage in favor of Adcetris arm, the A+AVD regimen, vs the standard of care. This regimen has shown very clearly, and for the first time in the last 20 years, that the addition of targeted agents in the regimen in frontline Hodgkin’s lymphoma can reduce by 41% the risk of death. This corresponds to a very high survival rate, at 6 years median follow-up, approaching 94%.

And, again, this may seem a very difficult target to get in many other types of lymphomas, as well as other types of cancer. So this is very important to have this overall survival benefit in young people, because they can go back to their families, go back to their normal lives, and continue living and enjoying their life with their family and friends.