ASH 2021 | A 10-year PFS simulation model based on the ECHELON-1 trial in Hodgkin lymphoma
Tycel Phillips, MD, University of Michigan, Ann Arbor, MI, discusses an oncology simulation model to estimate 10-year progression-free survival (PFS) and stem cell transplantation for classical Hodgkin lymphoma (cHL) with frontline brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD), based on the 5-year update of the ECHELON-1 trial (NCT01712490). This oncology simulation model for cHL anticipated that the durable PFS improvement of A+AVD versus ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), the most common frontline regimen, in the 5-year follow-up data from the ECHELON-1 study, resulted in an increasing number of patients who remained progression-free greater than 10 years and decreasing the number of patients having to proceed to secondary treatments, such as stem cell transplantation. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.
Transcript (edited for clarity)
In this ECHELON-1 study, which is really an observational study, basically what we wanted to look at is compare the real-world utilization and potentially future uptake of A+AVD versus ABVD, and to evaluate to see if the future uptake and anticipated uptake of A+AVD reduced the incidence of patients requiring transplantation or other secondary treatment options in patients with Hodgkin lymphoma...
In this ECHELON-1 study, which is really an observational study, basically what we wanted to look at is compare the real-world utilization and potentially future uptake of A+AVD versus ABVD, and to evaluate to see if the future uptake and anticipated uptake of A+AVD reduced the incidence of patients requiring transplantation or other secondary treatment options in patients with Hodgkin lymphoma. In general, Hodgkin lymphoma is an aggressive lymphoma currently with options of A+AVD, ABVD and [inaudible] depending on country of use.
In this situation from the original ECHELON-1 data, we know that A+AVD provided improvement in progression-free survival compared to ABVD, but obviously with the A+AVD there was a little bit higher incidence of infection rates and neutropenia. And so it does require GCSF. Uptake with A+AVD has been a bit slower than anticipated, but in the community it is picking up.
So in this, we did use a simulation model to simulate what we anticipate would be the uptake of A+AVD and really just summarize things, what we saw is that with the anticipated uptake of A+AVD you saw more patients anticipated to be alive and progression-free without relapse, and also less patients having to proceed to secondary treatments, such as autologous stem cell transplantation, other salvage regimens and potentially allogeneic stem cell transplantation.
So obviously this is a simulation model, not necessarily based on real data, but moving forward, it gives some sort of sense of idea of the decreasing number of patients we could actually avoid some of these secondary treatments. Now, moving forward, obviously we’ll have to compare some of the savings that you’ll get from avoidance of autologous stem cell transplantation to some of the costs that actually come with some of the extra supportive care that you need with A+AVD.
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