Rutherford Sarah C, Li Hongli, Herrera Alex F, LeBlanc Michael, Ahmed Sairah, Davison Kelly, Parsons Susan K, Unger Joseph M, Perry Anamarija M, Casulo Carla, Bartlett Nancy L, Tuscano Joseph M, Hess Brian T, Torka Pallawi, Kumar Pankaj, Jacobs Ryan, Song Joo Y, Castellino Sharon M, Kahl Brad, Leonard John P, Smith Sonali M, Friedberg Jonathan W, Evens Andrew M
Weill Cornell Medicine, New York, NY.
Fred Hutchinson Cancer Center, Seattle, WA.
J Clin Oncol. 2025 Jun 16:JCO2500204. doi: 10.1200/JCO-25-00204.
Older patients with classic Hodgkin lymphoma (cHL) have inferior survival compared with younger patients. We report a subset analysis of older patients (60 years and older) enrolled in the phase three S1826 trial conducted by SWOG that randomly assigned patients with newly diagnosed advanced-stage (III-IV) cHL to six cycles of nivolumab (N)-AVD or brentuximab vedotin (BV)-AVD. Of 103 enrolled patients 60 years and older, 99 were eligible. At a median follow-up of 2.1 years, the 2-year progression-free survival was 89% after N-AVD (n = 50) and 64% after BV-AVD (n = 49, HR 0.24, 95%CI 0.09-0.63, 1-sided stratified log-rank = .001). The 2-year OS was 96% with N-AVD versus 85% with BV-AVD (HR 0.16, 95%CI 0.03-0.75 stratified 1-sided log-rank = .005). Six cycles were delivered without dose reduction in 69% on N-AVD and 26% on BV-AVD; 55% discontinued BV, and 14% discontinued nivolumab. The nonrelapse mortality was 16% with BV-AVD and 6% with N-AVD. Despite more neutropenia with N-AVD, febrile neutropenia, sepsis, and infections were higher with BV-AVD, as was peripheral neuropathy. Patient-reported outcomes of key adverse events confirmed the improved toxicity profile of N-AVD over BV-AVD. N-AVD was better tolerated and more effective than BV-AVD and is therefore a new standard of care for older patients with advanced-stage cHL fit for anthracycline-based combination therapy.
与年轻患者相比，老年经典型霍奇金淋巴瘤（cHL）患者的生存率较低。我们报告了一项对年龄在60岁及以上的老年患者进行的亚组分析，这些患者参加了由SWOG开展的三期S1826试验，该试验将新诊断的晚期（III-IV期）cHL患者随机分为接受六个周期的纳武利尤单抗（N）-AVD方案或维布妥昔单抗（BV）-AVD方案治疗。在103名年龄60岁及以上的入组患者中，99名符合条件。在中位随访2.1年时，N-AVD方案组（n = 50）的2年无进展生存率为89%，BV-AVD方案组（n = 49）为64%（风险比0.24，95%置信区间0.09 - 0.63，单侧分层对数秩检验P = 0.001）。N-AVD方案组的2年总生存率为96%，BV-AVD方案组为85%（风险比0.16，95%置信区间0.03 - 0.75，分层单侧对数秩检验P = 0.005）。69%接受N-AVD方案的患者和26%接受BV-AVD方案的患者在六个周期治疗中未出现剂量减少；55%的患者停用了BV，14%的患者停用了纳武利尤单抗。BV-AVD方案组的非复发死亡率为16%，N-AVD方案组为6%。尽管N-AVD方案导致更多的中性粒细胞减少，但BV-AVD方案导致的发热性中性粒细胞减少、脓毒症、感染以及周围神经病变更多。患者报告的关键不良事件结局证实，N-AVD方案的毒性特征优于BV-AVD方案。N-AVD方案耐受性更好且比BV-AVD方案更有效，因此是适合基于蒽环类药物联合治疗的老年晚期cHL患者的新治疗标准。
