Transcript
Dr Andrew Evens: We are here live at the 2019 ASH Meeting in Orlando, Florida. Today, we'll be talking about key updates, as well as recently published data about brentuximab vedotin. My name is Dr Andy Evens. I'm really happy to have here several national/international experts in classical Hodgkin lymphoma, Dr Julie Vose, Dr Jonathan Friedberg, and Dr Steve Ansell.
Before talking about the 5 key ASH abstracts relating to brentuximab vedotin, we want to talk about data relating to ECHELON-1 that we know was a prior plenary session and published in the New England Journal.
I'm going to first ask Dr Vose just really now a couple years later, we've known this data for a little while. What do you think about it? How has it impacted your practice overall? Any subgroups you think about it?
Dr Julie Vose: Yes. We've definitely implemented it in our practice mostly with respect to high-risk patients, patients who have an IPS of 4 or more on the original forest plot. In further follow-up, it seems that the high-risk patients had the most benefit from that addition. We have not implemented it for all of our patients but have implemented it for those high-risk patients.
I would have to say I think it does have increased toxicity. I am always concerned and monitor patients very carefully, and have used it mostly in the younger patients due to that increased toxicity. With appropriate follow-up and close monitoring, it's definitely been something that I think has improved the outcomes for those patients.
Dr Evens: Dr Ansell, would it be similar? What do you think about mitigating those toxicities? How are you managing that?
Dr Stephen Ansell: I think there's a bit of a trade-off. Bleomycin obviously has been a problem in the past. The benefit of this regimen is you don't have to worry about that. Additional is that you can go ahead and treat. There is more neutropenia, but Neulasta or another bone marrow stimulating agent is typically added.
In some respects, it's a little bit of a set it and leave it approach, which actually can be quite helpful. Like Julie said, we also have embraced that and used it predominantly in our high-risk patients, in particularly stage 4 patients where we think that brings extra benefit.
Dr Evens: Growth factor, are you using out of the gate, priority, cycle one?
Dr Ansell: I think we learned that from the ECHELON-1 study that you really need to do that. Otherwise, neutropenia will catch up with you. Again, data that you published many years ago said that you can treat even with substantial neutropenia, but I think brentuximab vedotin brings a little more than that. For safety, it's really important to make sure that you add Neulasta right away.
Dr. Evens: Dr Friedberg, what about next steps? We have this data, it's here. Where are we going now?
Dr Jonathan Friedberg: I think we're excited about these data as well. In fact, at our institution, we're probably using it for more patients. The alternative of a PET-adapted approach is challenging in our rural area because many of our patients are not getting PET scans that are read the appropriate way. Using an approach like the ECHELON approach really mitigates that concern.
Moving forward, the United States cooperative groups have a randomized clinical trial currently open and accruing. Every group is participating, including the Children's Oncology Group and the Canadian Group for patients ages 12 and above, randomizing patients to the AVD-brentuximab as per ECHELON-1 regimen versus AVD and the nivolumab.
We're very excited about this trial. It's going to enroll about 1,000 patients. I think it will definitively answer the question about whether there are groups of patients that may benefit from one of these novel agents in Hodgkin lymphoma.
Dr Evens: That's fantastic. I know the overall study is important. Don't you have embedded some really important correlative analyses, quality of life, etc.?
Dr Friedberg: Yeah. In fact, based on some of the toxicity concerns, we have special neuropathy scoring. We're looking not only at early, but late toxicities of therapy which are so important for this young patient population. We have planned a number of correlative analyses really targeting groups of patients that may particularly benefit from checkpoint blockade.
Dr Evens: Great. More to come on that. Really, really exciting. Please look for that cooperative group NCI study open now on that.
Watch part 2: Brentuximab Vedotin Plus AVD Promising in HIV-Associated Classical Hodgkin Lymphoma
