Anti-CD30 (Brentuximab Vedotin) With AVD Versus ABVD Chemotherapy Protocol Frontline Therapy in Patients With Advanced Classical Hodgkin Lymphoma

Helwan University60 enrolled

Overview

This study will be held in the clinical oncology department, Helwan University, and Police Hospital, aiming to compare the efficacy and safety of anti-CD30 (BV) + Doxorubicin, Vinblastine, and Dacarbazine (AVD) versus the standard of care Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine (ABVD) as frontline therapy in patients with advanced classical Hodgkin lymphoma.

Hodgkin lymphoma (HL) is a malignancy that typically originates from germinal center B-lymphocytes. It is subdivided into classical type, which represents 95% of histopathology of HL cases (with four histological subtypes, namely, nodular sclerosis, mixed-cellularity, lymphocyte-rich, and lymphocyte-depleted), and nodular lymphocyte-predominant HL. For patients with newly diagnosed Ann Arbor stage III/IV (advanced stage) HL, 70% are expected to be cured after treatment with Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine (ABVD), which has been the preferred standard of care in the United States for many years. The Risk-adapted therapy for advanced-stage Hodgkin lymphoma (RATHL) study assessed de-escalation to Doxorubicin, Vinblastine, and Dacarbazine (AVD) in patients with stage IIB, III, or IV HL (Deauville 1-3) and found that positron emission tomography (PET)-adapted de-escalation to AVD failed to demonstrate noninferiority compared with ABVD.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Anti-CD30

Interventions

Brentuximab Vedotin + Doxorubicin, Vinblastine, and DacarbazineDRUG

Patients received Brentuximab Vedotin (BV)+ Doxorubicin, Vinblastine, and Dacarbazine (AVD) drug regimen by intravenous infusion on Days 1 and 15 of each 28-day cycle.

Doxorubicin, Bleomycin, Vinblastine, and DacarbazineDRUG

Patients received Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine (ABVD) drug regimen by intravenous infusion on Days 1 and 15 of each 28-day cycle.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age: 18- 70 Years. * Histopathology: confirmed classical Hodgkin Lymphoma according to the current World Health Organization (WHO) classification. CD30 positive by immunohistochemistry. * Stage III or IV Hodgkin lymphoma (HL) by the Ann Arbor classification system. * Treatment-naïve. * Laboratory: * complete blood count: absolute neutrophil counts (≥1500 per cubic millimeter), platelet counts (≥75,000 per cubic millimeter), and hemoglobin levels (≥8 g per deciliter) (except for patients with involvement of the marrow). * liver function test: total bilirubin level \<1.5 times the upper limit of normal and alanine aminotransferase or aspartate aminotransferase levels \<3 times the upper limit of normal. * kidney function test: serum creatinine level, \<2.0 mg per deciliter or creatinine clearance or calculated creatinine clearance, \>40 ml per minute. * Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2. Exclusion Criteria: * Histopathology: Nodular lymphocyte predominant Hodgkin lymphoma and non-Hodgkin lymphoma. * Cerebral/meningeal disease. * Prior treatment with chemotherapy, radiotherapy, or any immunotherapy within 12 weeks of first study drug dose. * Known human immunodeficiency virus (HIV) positive, known hepatitis B surface antigen-positive, or known active hepatitis C infection. * Known organ failure. * Cardiac: left ventricular ejection fraction \< 50%, myocardial infarction within 2 years of randomization or current uncontrolled cardiovascular conditions, including arrhythmias, congestive heart failure, angina, evidence of acute ischemia, or active conduction system abnormalities. * Female patients who are breastfeeding or having a positive serum pregnancy test during the randomization period or on day 1 before starting treatment. * Neurotoxicity, including symptomatic neurologic disease, comprising normal daily activities, any sensory or motor peripheral neuropathy. * Pulmonary diffusion capacity \>25 % lower than predicted value as retrieved by pulmonary function test for each patient before randomization. * Known hypersensitivity to recombinant proteins, murine proteins, or any component of the included drugs formulation.

Outcomes

Primary Outcomes

Progression-free survival

Progression-free Survival was recorded.

Time frame: 2 years post-procedure

Secondary Outcomes

Overall response rate

Overall Response Rate (ORR) is the percentage of participants who achieved complete remission (CR) or partial remission (PR) at the end of treatment with randomized regimen.

Time frame: 30 days after the end of treatment

Overall survival

Overall survival was recorded.

Time frame: 2 years post-procedure

Incidence of adverse events

Incidence of adverse events such as toxicity, incidence, severity and type starting after administration of the first dose till 30 days after end of frontline therapy were recorded.

Time frame: 30 days after the end of frontline therapy