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Frontline brentuximab vedotin in combination with dacarbazine or bendamustine in patients aged ≥60 years with HL

Jonathan W. Friedberg, Andres Forero-Torres, Rodolfo E. Bordoni, Vivian J. M. Cline, Dipti Patel Donnelly, Patrick J. Flynn, Gregg Olsen, Robert Chen, Abraham Fong, Yinghui Wang and Christopher A. Yasenchak

Key Points

  • BV plus DTIC is an active and well-tolerated combination for patients aged ≥60 years with HL.

  • Although highly active at the doses evaluated, BV plus bendamustine has unacceptable toxicity in patients aged ≥60 years with HL.

Publisher's Note: There is an Inside Blood Commentary on this article in this issue.

Abstract

Patients aged ≥60 years with treatment-naive Hodgkin lymphoma (HL) have few treatment options and inferior survival due to treatment-related toxicities and comorbidities. This phase 2, nonrandomized, open-label study evaluated brentuximab vedotin (BV) monotherapy (results previously reported), BV plus dacarbazine (DTIC), and BV plus bendamustine. Patients had classical HL and were ineligible for or declined frontline chemotherapy. Twenty-two patients received 1.8 mg/kg BV and 375 mg/m2 DTIC for up to 12 cycles, and 20 more patients received 1.8 mg/kg BV plus 90 or 70 mg/m2 bendamustine for up to 6 cycles (dose reduced due to toxicity). Subsequent BV monotherapy was allowed. Approximately 30 patients were to receive BV plus bendamustine; however, the incidence of serious adverse events (65%) and 2 deaths on study led to discontinuation of bendamustine and cessation of enrollment. Most patients had stage III/IV disease, and approximately half had ≥3 comorbidities or were impaired in ≥1 aspect that significantly interfered with quality of life. For BV plus DTIC, the objective response rate (ORR) was 100% and the complete remission (CR) rate was 62%. To date, the median progression-free survival (PFS) is 17.9 months. For BV plus bendamustine, the ORR was 100% and the CR rate was 88%. Neither the median PFS nor overall survival was reached. For elderly patients with HL, BV plus DTIC may be a frontline option based on tolerability and response duration. Despite activity, BV plus bendamustine is not a tolerable regimen in these patients. This trial was registered at www.clinicaltrials.gov as #NCT01716806.

  • Submitted June 13, 2017.
  • Accepted October 3, 2017.
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