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BSH 2022 | Hodgkin lymphoma updates in the UK: ECHELON-1

Wendy Osborne, MBBS (Hons), MRCP, FRCPath, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK, shares some insights into frontline treatment of patients with Hodgkin lymphoma (HL). Dr Osborne first explains the ongoing discussion surrounding the use of escalated BEACOPP versus a standard RATHL approach in the UK. Following this, Dr Osborne highlights the importance of the ECHELON-1 trial (NCT01712490) investigating the use of brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) versus doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in patients with HL. Results from this trial indicate an overall survival benefit, but Dr Osborne explains that further analysis of the results and a better understanding of the reason behind this survival benefit are important before knowing how this will influence treatment in the UK. This interview took place at the 62nd Annual Scientific Meeting of the British Society for Haematology (BSH) 2022, in Manchester, UK.

Transcript (edited for clarity)

Okay, so moving on to Hodgkin lymphoma, and I think frontline Hodgkin lymphoma is still a big discussion in our MDT because we really want to discuss whether we use a more intensive, escalated BEACOPP. So in the UK, we use escalated BEACOPDac, replacing procarbazine with dacarbazine, which from our current audit data looks as if it’s still as effective but is less toxic. Whether we use this escalated BEACOPDac approach, following the HD18 with an excellent progression-free survival, versus a RATHL approach, which is less toxic, but the progression-free survival is inferior compared to the HD18...

Okay, so moving on to Hodgkin lymphoma, and I think frontline Hodgkin lymphoma is still a big discussion in our MDT because we really want to discuss whether we use a more intensive, escalated BEACOPP. So in the UK, we use escalated BEACOPDac, replacing procarbazine with dacarbazine, which from our current audit data looks as if it’s still as effective but is less toxic. Whether we use this escalated BEACOPDac approach, following the HD18 with an excellent progression-free survival, versus a RATHL approach, which is less toxic, but the progression-free survival is inferior compared to the HD18.

And we know that for stage IV disease, using brentuximab vedotin as per the ECHELON-1 approach, so in combination with ABVD, has an approval, but it hasn’t been any uptake in the UK. And I think that’s because of lots of discussion about trial design, about the modified progression-free survival endpoint, about using six cycles of bleomycin in the standard arm, which we wouldn’t tend to do. And so it hasn’t been something we’ve done. Now, there has been more recently a press release telling us that there is an overall survival benefit in the patients who had the BV containing arm. Now that is potentially really exciting, and that’s exciting because we haven’t seen any data showing us a survival benefit. What we need to see is why there is that survival benefit. And I think before I would comment upon whether that may be practice changing in the UK and go for NICE approval, I want to see why that survival benefit is there. And it’s going to be presented, I understand, at EHA this year. Because if it is a true survival benefit because of disease control, then yes, I would be very interested in using that for patients, for some selected patients maybe. But if it’s a survival benefit because the standard arm there was too much toxicity, because for example, they had too much bleomycin, then that makes it of less relevance possibly. So yes, I’m excited. Any trial that shows survival benefit is important, but obviously I want to really see that data before commenting further as to what impact that could have on the UK.

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