A phase III trial conducted by SWOG S1826 has revealed that the immune checkpoint inhibitor nivolumab (Opdivo) is more effective than brentuximab vedotin (Adcetris) in reducing disease progression or death in newly diagnosed adults and adolescents with advanced-stage classical Hodgkin lymphoma (cHL).
The trial involved over 976 patients with newly diagnosed stage III-IV cHL who received six cycles of doxorubicin (Adriamycin), vinblastine, and dacarbazine (AVD) plus either nivolumab or brentuximab. At the one-year mark, 94% of patients in the nivolumab group were alive and free of disease progression as compared to 84% in the brentuximab group. The nivolumab-AVD regimen “is poised to be a new standard therapy for advanced-stage Hodgkin lymphoma,” said Alex Francisco Herrera, MD, of City of Hope in Duarte, California. The trial met its primary endpoint for progression-free survival (PFS) improvement.
Patients in the nivolumab group were more likely to develop neutropenia, but were less likely to require granulocyte colony-stimulating factor (G-CSF) and experience bone pain and neuropathy. They were also less likely to discontinue nivolumab than brentuximab vedotin.
Herrera pointed out that less than 1% of patients in both arms ultimately underwent radiation therapy, which is associated with second tumors and cardiac damage. There were 11 deaths in the brentuximab group, seven of which were toxicity-related, while four deaths in the nivolumab group were related to adverse events.
Melissa Hudson, MD, of St. Jude Children’s Research Hospital in Memphis, Tennessee, emphasized that patients need follow-up to assess the long-term impact of the two regimens. “Both these agents show that patients respond to their use, and both are effective,” she told MedPage Today. “Whether one is better than the other, especially in the pediatric patient population, in the long-term still has to be determined.”
Herrera reported that nivolumab plus AVD was more effective in the adult groups, but that in children, the PFS difference was not statistically significant, although it trended in favor of the nivolumab arm. Hudson, who was not involved in the study, noted that pediatricians are wary when it comes to adopting new treatments. She also said that insurance coverage plays a role in how quickly a new regimen is accepted.
The SWOG S1826 trial has shown that nivolumab outperforms brentuximab vedotin in reducing disease progression or death in newly diagnosed adults and adolescents with advanced-stage classical Hodgkin lymphoma (cHL). However, long-term follow-up is needed to assess the efficacy of the two regimens, especially in pediatric patients.