The following article features coverage from the 2021 Annual Meeting of the Society of Hematologic Oncology (SOHO). Click here to read more of Cancer Therapy Advisor’s conference coverage.

The survival benefits seen with brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP) persist at 5 years, according to updated results from the ECHELON-2 trial.1

Prior results had shown that frontline A+CHP improves progression-free survival (PFS) and overall survival (OS) when compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in patients with CD30-positive peripheral T-cell lymphomas (PTCLs).2

The updated 5-year outcomes were presented at the Annual Meeting of the Society of Hematologic Oncology (SOHO) by Swaminathan Iyer, MD, of MD Anderson Cancer Center in Houston, Texas.


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The phase 3 ECHELON-2 trial (ClinicalTrials.gov Identifier: NCT01777152) randomized 452 patients with CD30-positive PTCL, 316 of whom had systemic anaplastic large-cell lymphoma (sALCL).

The patients were assigned to receive A+CHP (226 patients) or CHOP (226 patients). The baseline patient demographics and disease characteristics were well-balanced between the treatment arms.

At 5 years, A+CHP reduced the risk of progression, death, or receipt of subsequent anticancer therapy by 30% compared with CHOP.

At a median follow-up of 47.6 months, the median PFS was 62.3 months in the A+CHP arm and 23.8 months in the CHOP arm. The 5-year PFS rates were 51.4% and 43.0%, respectively (hazard ratio [HR], 0.70; 95% CI, 0.53-0.91; P =.007).

For the subset of patients with sALCL, there was a 45% reduction in the risk of progression, death, or receipt of subsequent anticancer therapy with A+CHP compared with CHOP. The median PFS was not reached in the A+CHP arm and was 54.2 months in the CHOP arm (HR, 0.55; 95% CI, 0.39-0.79; P =.0009).

For the entire cohort, A+CHP reduced the risk of death by 28%. At a median follow-up of 66.8 months, the median OS was not reached in either treatment arm (HR, 0.72; 95% CI, 0.53-0.99; P =.0424).

In the sALCL subset, A+CHP reduced the risk of death by 34% (HR, 0.66; 95% CI, 0.43-1.01). The reduced risk of death was greater among patients with ALK-positive sALCL (HR, 0.48; 95% CI, 0.16-1.40) than among those with ALK-negative disease (HR, 0.71; 95% CI, 0.44-1.12).

There were 29 patients in the A+CHP arm who received brentuximab vedotin retreatment after completing frontline therapy and 54 patients in the CHOP arm who received their first brentuximab vedotin treatment after frontline therapy.

Retreatment produced an objective response rate (ORR) of 59%, with 11 complete responses and 6 partial responses. In the CHOP arm, the ORR with brentuximab vedotin was 50%, with 16 patients achieving a complete response and 11 having a partial response.

Treatment-emergent peripheral neuropathy (PN) events were reported in 117 patients in the A+CHP arm and 124 patients in the CHOP arm. PN resolved or improved in 72% of patients in the A+CHP arm and 78% of those in the CHOP arm. 

“At 5 years, frontline treatment with A+CHP continues to provide clinically meaningful improvement in PFS and overall survival vs CHOP,” Dr Iyer said in closing. “In the intent-to-treat population and in the systemic ALCL subset, A+CHP was associated with a significant reduction in the receipt of subsequent cancer therapies and risk of progression event or death.”

Disclosures: This research was supported by Seagen and Millennium Pharmaceuticals. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Read more of Cancer Therapy Advisor’s coverage of SOHO 2021 by visiting the conference page.

References

  1. Iyer S, Trümper L, O’Connor OA, et al. The ECHELON-2 trial: 5-year results of a randomized, double-blind, phase 3 study of brentuximab vedotin and CHP (A+CHP) versus CHOP in frontline treatment of patients with CD30-positive peripheral T-cell lymphoma. Paper presented at: Annual Meeting of the Society of Hematologic Oncology (SOHO); September 8-11, 2021.
  2. Horwitz S, O’Connor OA, Pro B, et al. Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial. Lancet. 2019;393(10168): 229-240. doi: 10.1016/S0140-6736(18)32984-2