734 | REAL‐WORLD OUTCOMES OF FRONTLINE BRENTUXIMAB VEDOTIN IN OLDER PATIENTS WITH CLASSICAL HODGKIN LYMPHOMA ‐AN INTERNATIONAL, MULTI‐CENTER STUDY

Le résumé fourni par la source

Introduction: Despite favorable outcomes in younger pts with cHL, those aged ≥ 60, have inferior survival, due to disease biology (e.g., mixed cellularity, EBVþ, advanced-stage disease) and comorbidities impacting treatment-related toxicity.Brentuximab vedotin (BV) plus AVD (doxorubicin, vinblastine, dacarbazine) is approved for frontline treatment (tx) based on ECHELON-1, but its use in older adults (OA) is limited by toxicity.A phase 2 study (Evens et al., JCO 2018) suggested sequential (SEQ) BV-AVD may improve safety over concurrent approach (CON).This study evaluated real-world experience with SEQ and CON BV-AVD in OA with cHL.Methods: This retrospective multicenter study included OA (age ≥ 60) with cHL, diagnosed between 03/2013-04/2023 at five international centers.Data collected included demographics, comorbidities (CIRS-G score), AEs, treatment modifications, PFS, and OS.Results: Among 129 pts, median age was 72 years (IQR 67-76), 65% male, with median CIRS-G 5 (IQR 3, 8), 33% had prior malignancy, 54% stage IV, and 46% EBVþ.Fifty (39%) received CON, 56 (43%) SEQ BV-AVD, and 23 (18%) BV monotherapy or BV-based palliative tx.Baseline characteristics were comparable between SEQ and CON, except for EBVþ (SEQ: 56%, CON: 32%, p = 0.04).At a median follow-up of 2.3 years (range 0.1-9.4),2-year PFS and OS were 65% (95% CI: 56-74%) and 82% (95% CI: 75-90%).Excluding palliative tx, 2-year PFS and OS were 72% (95% CI: 63-82%) and 87% (95% CI: 81-94%), respectively.No significant difference in PFS and OS was observed between SEQ and CON BV-AVD (p = 0.3 and 0.6, respectively).In multivariable analysis adjusting for age or EBV status, regimen was not a predictor of PFS (p = 0.4 in both).Among 106 pts treated with curative intent, only 48% completed the full regimen, primarily due to BV omission.Treatment was interrupted in 33% and dose-reduced in 52%, primarily involving BV.However, 70% completed six cycles of AVD.The most common AEs were neuropathy (all: 44%; CON: 45%; SEQ: 46%), infections (all: 29%; CON: 31%; SEQ: 27%), and neutropenic fever (all: 19%; CON: 26%; SEQ: 12%).Rates of completion, interruptions, and dose reductions did not differ between regimens.During follow-up, 20 pts receiving curative tx died: 5 from infections (including 3 COVID-19), 7 from progression, and 8 from comorbidities.Among 33 relapsed/refractory cases, 4 died upon progression, 1 declined further tx, and 2 had missing follow-up.One continued BV, 13 received PD-1-based tx, and 12 underwent chemotherapy.Conclusions: In this real-world analysis, SEQ BV-AVD showed comparable efficacy and safety to the prior phase 2 data.In contrast, CON BV-AVD compared favorably to ECHELON-1 data and appeared like SEQ BV-AVD, potentially due to patient selection.Given the higher toxicity observed with CON in ECHELON-1 and S1826, fitness and comorbidity assessment are likely crucial in guiding tx choice for OA cHL patients with contraindications for checkpoint blockade.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.