Brentuximab Vedotin Combined With AVD Chemotherapy in Patients With Newly Diagnosed Early Stage, Unfavorable Risk Hodgkin Lymphoma

Memorial Sloan Kettering Cancer Center (MSK)

Status: Active, not recruiting

Conditions: Hodgkin Lymphoma

Treatments: Radiation: Involved-Site Radiation Therapy (ISRT); Drug: Doxorubicin HCL; Drug: Dacarbazine; Radiation: consolidation volume RT (CVRT); Drug: Brentuximab vedotin (SGN-35); Drug: Vinblastine Sulfate; Procedure: Interim PET

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT01868451

13-034

Details and patient eligibility

About

The purpose of this study is to compare the outcomes across the 4 different treatment groups. The investigators hope that this treatment will improve the ability to cure more patients with HL and also limit the long-term side effects from the treatment. Although eliminating radiation in cohort 4 will eliminate the risk for long-term side effects from radiation, it is also possible that with BV+AVD chemotherapy alone there may be an increased risk of the Hodgkin lymphoma coming back after initial treatment.

Enrollment: 118 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Histologic diagnosis of classical, CD30 positive Hodgkin lymphoma confirmed at enrolling institution
• FDG-avid disease by FDG-PET/CT and measurable disease of at least 1.5 cm by CT
• Ann Arbor Stage I or II disease
• Disease bulk defined as any lymph node mass with transverse maximal diameter > 7.0 cm OR coronal maximal diameter > 7.0 cm on CT imaging
• Females of childbearing age must be on an acceptable form of birth control per institutional standards
• Ages 18 and over

Exclusion criteria

• Cardiac ejection fraction ≤ 50%
• Hemoglobin-adjusted diffusing capacity for carbon monoxide < 40%
• ANC≤1000/μl and Platelets≤75,000/μl
• Total bilirubin ≥ 2.0 mg/dl in the absence of a history of Gilbert's disease
• Serum creatinine clearance of <30 mL/min as estimated by the Cockcroft-Gault Method
• Known pregnancy or breast-feeding
• Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS)
• Medical illness unrelated to Hodgkin Lymphoma, which, in the opinion of the attending physician and/or MSKCC principal investigator, makes participation in this study inappropriate.
• Peripheral neuropathy > grade 1
• Patients receiving chronic treatment with systemic steroids. However, patients can receive up to 10 days of steroid therapy prior to starting treatment with BV+AVD.

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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118 participants in 4 patient groups

Cohort 1 (completed accrual)

Experimental group

Description:

Patients received 4 cycles of brentuximab vedotin \& AVD chemotherapy. Brentuximab vedotin, 1.2 mg/kg, will be administered on days 1 and 15 of each 28 day cycle. Doxorubicin 25 mg/m2, Vinblastine 6 mg/m2, \& Dacarbazine 375 mg/m2 will be administered on days 1 and 15 of each 28 day cycle. This may be followed by 30 Gy involved site radiotherapy. Involved site radiotherapy should be initiated from 12 days to 42 days after completion of chemotherapy. It is mandatory to administer prophylactic growth factor support starting with cycle 1. Choice of growth factor and dosing can be determined at the discretion of the treating physican.

Treatment:

Procedure: Interim PET

Drug: Vinblastine Sulfate

Drug: Brentuximab vedotin (SGN-35)

Drug: Dacarbazine

Drug: Doxorubicin HCL

Radiation: Involved-Site Radiation Therapy (ISRT)

Cohort 2

Experimental group

Description:

Patients with early stage, unfavorable risk Hodgkin lymphoma. The definition of disease bulk, one of the unfavorable risk features, has been updated, and is defined as the presence of any lymph node mass with transverse maximal diameter \> 7.0 cm OR coronal maximal diameter \> 7.0 cm. Patients will receive 4 cycles of brentuximab vedotin \& AVD chemotherapy. Brentuximab vedotin, 1.2 mg/kg, will be administered on days 1 and 15 of each 28 day cycle. Doxorubicin 25 mg/m2, Vinblastine 6 mg/m2, and Dacarbazine 375 mg/m2 will be administered on days 1 \& 15 of each 28 day cycle. This may be followed by 20 Gy involved site radiotherapy.

Treatment:

Procedure: Interim PET

Drug: Vinblastine Sulfate

Drug: Brentuximab vedotin (SGN-35)

Drug: Dacarbazine

Drug: Doxorubicin HCL

Radiation: Involved-Site Radiation Therapy (ISRT)

Cohort 3

Experimental group

Description:

Patients will have early stage, unfavorable risk classical Hodgkin lymphoma with disease bulk defined as the presence of any lymph node mass with transverse maximal diameter \> 7.0 cm or coronal maximal diameter \> 7.0 cm. Patients will receive 4 cycles of brentuximab vedotin and AVD chemotherapy. Brentuximab vedotin, 1.2 mg/kg, will be administered on days 1 and 15 of each 28 day cycle. Doxorubicin 25 mg/m2, Vinblastine 6 mg/m2, and Dacarbazine 375 mg/m2 will be administered on days 1 and 15 of each 28 day cycle. This may be followed by 30.6 Gy CVRT.

Treatment:

Procedure: Interim PET

Drug: Vinblastine Sulfate

Drug: Brentuximab vedotin (SGN-35)

Radiation: consolidation volume RT (CVRT)

Drug: Dacarbazine

Drug: Doxorubicin HCL

Cohort 4

Experimental group

Description:

Patients will have early stage, unfavorable risk classical Hodgkin lymphoma with disease bulk defined as the presence of any lymph node mass with transverse maximal diameter \> 7.0 cm or coronal maximal diameter \> 7.0 cm. In this cohort. Pts will receive 4 cycles of brentuximab vedotin \& AVD chemo. Brentuximab vedotin, 1.2 mg/kg, will be administered on days 1 \& 15 of each 28 day cycle. Doxorubicin 25 mg/m2, Vinblastine 6 mg/m2, \& Dacarbazine 375 mg/m2 will be administered on days 1 \& 15 of each 28 day cycle. Pts whose PET scan is negative after 4 cycles of brentuximab vedotin \& AVD chemotherapy will not receive RT. Pts whose PET scan is positive after 4 cycles of brentuximab vedotin \& AVD chemo, but subsequent biopsy is neg, will also receive no RT. Upon MSK PI approval, if the simulation can't be covered by the institution or the pts insurance, a diagnostic IV contrast CT neck \& diagnostic IV contrast CT CAP scan will be done in addition to the FDG-PET done after 4 cycles of chemo.

Treatment:

Procedure: Interim PET

Drug: Vinblastine Sulfate

Drug: Brentuximab vedotin (SGN-35)

Drug: Dacarbazine

Drug: Doxorubicin HCL