A new study showed that BrECADD, a novel therapy combination, cured classic Hodgkin lymphoma more effectively and with fewer side effects than the established intensive chemotherapy regimen BEACOPP. The research was be presented at the 2024 American Society of Clinical Oncology (ASCO).

“Classic Hodgkin lymphoma can be cured with chemotherapy in most patients. However, the cure is accompanied by the cost of acute, chronic, and sometimes long-lasting severe side effects. With this new BrECADD regimen, we aimed to improve the balance of risks and benefits of effective systemic treatment,” said lead study author Peter Borchmann, MD, University Hospital of Cologne, and Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf and German Hodgkin Study Group.

In the GHSG HD21 trial, 742 patients were randomised to receive BrECADD and 740 to receive BEACOPP. BrECADD includes the medications brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone while BEACOPP includes bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone. Patients were an average age of 31 years, and 7 of every 10 patients were younger than 40.

The researchers used positron-emission tomography to help decide whether to give patients four or six cycles of treatment. If the cancer responded well to the treatment as shown by relatively cancer-free PET scans after two cycles, then fewer cycles of treatment would be given. If the cancer did not respond to treatment, more cycles would be given. 

Key Findings

At 4 years follow-up, 430 patients (64%) receiving BrECADD and 430 patients (64%) receiving BEACOPP were eligible for fewer treatment cycles.

The progression-free survival was 94.3% for BrECADD and 90.9% for BEACOPP, while overall survival was 98.5% for BrECADD and 98.2% for BEACOPP. 

Most significantly, people in the BrECADD group had a 34% lower risk of disease progression than those in the BEACOPP group. Most of the patients (64%) who were in the BrECADD group finished their treatment in four cycles (about 3 months).

Researchers also compared levels of follicle-stimulating hormone (FSH), which plays an important role in sexual development and fertility, in patients after treatment.

In men, FSH recovery rates were 67% in the BrECADD group and 24% in the BEACOPP group (FSH cut-off 12.4 U/l). In women, FSH recovery rates were 89% i the BrECADD group and 68% in the BEACOPP group (FSH cut-off 21.5 U/l).

There were 60 babies born in the BrECADD group, compared to 43 babies born in the BEACOPP group. 

The most common side effects were abnormal blood cell counts.

The researchers found that severe blood-related side effects arose in 31% of people in the BrECADD group and 52% of people in the BEACOPP group. Patients receiving BrECADD required fewer transfusions of red blood cells and platelets.

Side effects that were not blood-related were less frequent in both groups (19% for BrECADD and 17% for BEACOPP). Most serious side effects went away after one year.

“BEACOPP, a combination of seven anti-cancer drugs, is an effective treatment for advanced-stage classic Hodgkin lymphoma, but its use is limited by high rates of severe toxicities. In this trial, the BrECADD regimen, a combination of six anti-cancer drugs, reduced the risk of progression, relapse, or death from the disease and resulted in a strikingly high 4-year progression-free survival rate of 94.3%. Patients who received BrECADD also experienced fewer side effects and had higher fertility rates than patients who received BEACOPP.” - Oreofe O. Odejide, MD, MPH, Assistant Professor of Medicine, Dana-Farber Cancer Institute.

Next Steps

The researchers plan to explore ways to make the treatment more effective without causing more side effects. This could increase the number of patients who would only require four cycles of treatment. They are evaluating adding PD-1 inhibitors to the BrECADD regimen.

Source: ASCO