Upper echelon.

The CD30 antibody-drug conjugate brentuximab vedotin is looking to become the rituximab of Hodgkin lymphoma. The phase 3 ECHELON-1 trial randomized 1334 patients with stage III-IV Hodgkin lymphoma to six cycles of the classic upfront ABVD versus A-AVD. This latter regimen is one that drops the dreaded bleomycin and adds brentuximab vedotin (aka Adcetris). Initial reporting in 2018 brought us a promising separation in survival curves even at 6 months, but now we have final reporting on the secondary endpoint of overall survival. At a median follow-up of over 6 years, risk of death was nearly double after the standard ABVD than after A-AVD (HR 0.59). Rates of overall survival at 6 years were 89% versus 94%. We already know progression-free survival was improved with A-AVD, and this translated to significantly less second therapies. A-AVD also resulted in less second cancers but more febrile neutropenia and peripheral neuropathy. In the first acronym update in decades, substituting the CD30 antibody-drug conjugate brentuximab vedotin in place of bleomycin (aka A-AVD) improves overall survival for advanced Hodgkin lymphoma.  | Ansell, N Engl J Med 2022