Specialized treatments for classical Hodgkin lymphoma present clinicians with complex challenges, particularly concerning adverse events associated with chemotherapy regimens. Understanding these challenges is crucial for optimizing patient care and outcomes.
Dr. Rhodes discusses insights gleaned from the RATHL trial, emphasizing the contrasting AE profiles of escalated BEACOPP, bleomycin, etoposide phosphate, doxorubicin, cyclophosphamide, vincristine sulfate, procarbazine hydrochloride, and prednisone, and ABVD, doxorubicin hydrochloride, bleomycin, vinblastine, and dacarbazine. While BEACOPP shows higher rates of neutropenia and concerns about fertility and lung toxicity due to bleomycin, ABVD offers a gentler alternative with fewer severe AEs, albeit with potential long-term lung function issues from bleomycin exposure.
In contrast, the ECHELON-1 trial examined brentuximab vedotin, Adcetris, plus AVD, doxorubicin hydrochloride, vinblastine, and dacarbazine, versus ABVD in advanced stage cHL. Dr. Rhodes underscores that BV-AVD, despite showing promising efficacy, introduces unique challenges such as peripheral neuropathy, although it avoids lung toxicity associated with bleomycin in ABVD. The study also revealed differing profiles in secondary malignancies, with fewer hematologic malignancies noted in BV-AVD compared to ABVD, suggesting nuanced considerations in long-term treatment planning.
Peripheral neuropathy emerges as a notable AE with BV-AVD, albeit manageable over time, unlike the irreversible neurotoxicity seen with vincristine in other lymphoma treatments. Dr. Rhodes highlights the importance of early dose reductions in brentuximab vedotin to mitigate peripheral neuropathy without compromising treatment efficacy.
