A phase 3 clinical trial, SWOG S1826, has revealed that nivolumab (Opdivo) in combination with AVD (doxorubicin, vinblastine, and dacarbazine) significantly improves progression-free survival (PFS) in patients with stage III or IV advanced-stage classic Hodgkin lymphoma compared to the standard treatment of brentuximab vedotin plus AVD. The study, a collaborative effort across adult and pediatric oncology centers in North America, suggests a potential shift in the primary treatment approach for this patient population.
Superior Efficacy with Nivolumab Plus AVD
After a median follow-up of 2.1 years, the 2-year PFS rate with nivolumab plus AVD was 92% (95% CI, 89%-94%) compared to 83% (95% CI, 79%-86%) with brentuximab vedotin plus AVD, resulting in a hazard ratio of 0.45 (95% CI, 0.30-0.65). This indicates a significant reduction in the risk of disease progression or death with the nivolumab-containing regimen. According to Andrew M. Evens, DO, MBA, MSc, the trial results were a “double winner,” highlighting both improved efficacy and better tolerability.
Improved Safety Profile
In addition to superior efficacy, the nivolumab plus AVD regimen demonstrated a more favorable safety profile. High-grade adverse events were less frequent in the nivolumab arm, with the exception of neutropenia. Specifically, there was less neuropathy, fewer infections, and less sepsis compared to the brentuximab vedotin arm. This is clinically relevant, as it can lead to a better quality of life for patients undergoing treatment.
Implications for Clinical Practice
The findings from the SWOG S1826 trial suggest that nivolumab plus AVD could become a strong candidate for primary treatment in adolescent and adult patients with stage III or IV Hodgkin lymphoma. Alex F. Herrera, MD, chief of the Division of Lymphoma in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope, noted that the benefit with nivolumab plus AVD was consistent across diverse patient subgroups enrolled in the study.
Trial Design and Methodology
The SWOG S1826 trial (NCT03907488) was a phase 3 study that enrolled patients with newly diagnosed advanced-stage classical Hodgkin lymphoma across both adult and pediatric oncology centers in North America. Patients were randomized to receive either nivolumab plus AVD or brentuximab vedotin plus AVD. The primary endpoint was progression-free survival. The collaborative nature of the trial, involving both adult and pediatric groups, facilitated the timely completion of the study and ensured the broad applicability of the results.
