ICML 2025 | Insights into the BrECADD regimen for advanced HL & the significance of the HD21 study

The HD21 study, which was studying the BrECADD regimen in a randomized fashion to standard escalated BEACOPP, was a really important publication and breakthrough published in The Lancet last year. I was fortunate to write a commentary on that and it’s really just a brilliant study in the fact that yes it’s a more intensive treatment but what is done in that is one it incorporates brentuximab vedotin in lieu of bleomycin and other vinca alkaloid but also has some other important substitutions it substitutes dacarbazine in lieu of the more gonadotoxic procarbazine and also cuts down the steroids instead of long course of prednisone four days of dexamethasone. So that was important modifications, number one. Number two, the study was designed, all patients received two cycles of either regimen and then had a PET scan. And if your PET scan was negative after two cycles, you only received two more cycles of treatment in either arm. In other words, four total cycles. And about two-thirds of patients had a negative PET scan. For the ones that had a positive PET scan, they received four more cycles or six total. But another way to say it is for two-thirds of patients, it really was pretty condensed treatment. They finished treatment in 12 weeks, which fairly low anthracycline cumulative dose, and the outcomes were very robust. It was a 94% four-year progression-free survival for advanced-stage disease. Now, of course, we’ll need to look at quality of life, and they’ve done those analyses. They also had a subset in older patients over age 60. More dose modifications, as you could imagine, for older patients. And then obviously for all Hodgkin lymphoma studies in general, especially with cure rates over 90%, we need to follow for post-acute and late effects. What I mean by post-acute is you can start to see adverse effects from the treatment at one or two years later, up through ten years, and then for decades beyond. So obviously that will happen with time with BrECADD and all of the other regimens that are being studied.

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