denotes an abstract that is clinically relevant.
denotes that this is a recommended PHD Trainee Session.
denotes that this is a ticketed session.Session: 627. Aggressive Lymphomas: Pharmacologic Therapies: Poster II
Hematology Disease Topics & Pathways:
Research, Clinical trials, Combination therapy, Adult, Lymphomas, Non-Hodgkin lymphoma, Clinical Research, Diseases, Treatment Considerations, Lymphoid Malignancies, Study Population, Human
Relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) is very aggressive, with a historically low complete response (CR) rate (Blood. 2017; 130[16]:1800-1808). Recent research has focused on achieving complete and durable responses in this population, which translate to improvements in overall survival (OS) and progression-free survival (PFS). Results from the randomized, global, phase 3 ECHELON-3 study (NCT04404283) demonstrated a statistically significant and clinically meaningful improvement in OS, PFS, and objective response rate with brentuximab vedotin (BV) combined with lenalidomide (Len) and rituximab (R; BV+Len+R) vs placebo+Len+R in patients (pts) with R/R DLBCL after ≥2 prior systemic therapies. Here, we present subgroup analyses in pts with a best overall response (BOR) of CR (n=67).
Methods
Pts in the study were randomized (1:1) to receive BV (1.2 mg/kg) or placebo every 3 weeks, in combination with R (375 mg/m2) and Len (20 mg) once daily. In these subgroup analyses, eligible pts had a BOR of CR and some ended study treatment and received any subsequent anticancer therapy. BOR was assessed by investigators according to the Lugano 2014 classification. Duration of response was defined as the time from the start of the first documented CR to the first documented tumor progression per Lugano 2014 or death. Pts who initiated a subsequent nonpalliative anticancer therapy were censored at the most recent prior response assessment. Subsequent nonpalliative anticancer therapies were defined as any systemic therapy received after the end of study treatment. P values are descriptive.
Results
Of the 112 pts in the BV+Len+R group, 45 (40.2%) had a BOR of CR. Of the 118 pts in the placebo+Len+R group, 22 (18.6%) had a BOR of CR. The median duration of CR was 18.9 months (95% CI, 11.1 months-not estimable [NE]) with BV+Len+R vs not reached (NR) with placebo+Len+R (hazard ratio [HR], 0.527; 95% CI, 0.200-1.389; P=.1891). The median time to CR was 1.58 months (range, 1.2-7.3 months) with BV+Len+R and 1.61 months (range, 0.7-4.6 months) with placebo+Len+R. With a median follow-up of 14.3 months, the median OS in pts with a BOR of CR was 31.5 months (95% CI, 20.3 months-NE) in the BV+Len+R group vs NR in the placebo+Len+R group (HR, 1.044; 95% CI, 0.331-3.298; P=.9407). Median PFS in pts with a BOR of CR was 21.5 months (95% CI, 12.6 months-NE) in the BV+Len+R group vs NR (95% CI, 5.4 months-NE) in the placebo+Len+R group (HR, 0.6333; 95% CI, 0.256-1.567; P=.3198). Results of NR in the placebo+Len+R group are likely attributable to limited follow-up and small sample size. Additional data on baseline characteristics of pts who had CR will be presented.
Of the 45 pts with CR in the BV+Len+R group, 42 (93.3%) received no subsequent anticancer therapy. Of the 22 pts with CR in the placebo+Len+R group, 17 (77.3%) received no subsequent anticancer therapy.
Conclusions
BV doubled the CR rate in pts with R/R DLBCL compared with placebo, and outcomes in pts with CR were durable, with only 6.7% of pts treated with BV+Len+R receiving subsequent systemic anticancer therapy, compared with 22.7% of pts treated with placebo+Len+R receiving subsequent therapy. Overall, BV+Len+R demonstrated a survival benefit in the ECHELON-3 study and is a promising option to achieve complete and durable responses in third- or later-line therapy for pts with R/R DLBCL.
Disclosures: Yasenchak: Pfizer: Consultancy; Beigene: Speakers Bureau. Bartlett: Forty Seven: Research Funding; Celegne: Research Funding; Gilead: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees; Genmab: Membership on an entity's Board of Directors or advisory committees, Research Funding; ADC Therapeutics: Research Funding; BMS: Research Funding; Foresight Diagnostics: Membership on an entity's Board of Directors or advisory committees; Autolus: Research Funding; Washington University School of Medicine: Current Employment; Seattle Genetics: Research Funding; Roche/Genentech: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Research Funding; Kite Pharm: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Research Funding; Millennium: Research Funding. Kim: St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea: Current Employment; Ministry of Science and Technology of Korea: Research Funding. Portell: Merck, Prelude, BeiGene, AstraZeneca, SeaGen/Pfizer, Infinity, Genentech/Roche, Kite: Research Funding; Merck, BeiGene, Jansen, AstraZeneca, AbbVie: Consultancy. Zaja: Novartis, Sobi, Amgen, Grifols, Argenx, Hutchmed, Lilly, Abbvie: Honoraria; Novartis, Sobi, Amgen, Grifols: Research Funding; Novartis, Grifols, Argenx: Membership on an entity's Board of Directors or advisory committees. Zenz: Incyte: Consultancy, Honoraria; Gilead Sciences: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Roche: Consultancy, Honoraria; BeiGene: Consultancy, Honoraria; Lilly: Consultancy, Honoraria. Forsyth: AstraZeneca: Honoraria; Alexion: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Alexion: Honoraria; Novartis: Honoraria; GlaxoSmithKline: Membership on an entity's Board of Directors or advisory committees. Kim: Roche: Other: All authors received support for third-party writing assistance, furnished by Akshaya Srinivasan, PhD, CMPP, of Nucleus Global, an Inizio company, and funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland.. Ghesquieres: Gilead, Roche, BMS, Abbvie, Takeda: Honoraria; Roche, BMS, Takeda: Consultancy. Nowakowski: Karyopharm Therapeutics: Consultancy; AbbVie Inc.: Consultancy; Fate Therapeutics: Consultancy; Celgene Corporation: Consultancy, Research Funding; Ryvu Therapeutics: Consultancy; Incyte Corporation: Consultancy; MEI Pharma: Consultancy; Segen: Consultancy; Kymera Therapeutics: Consultancy; Curis: Consultancy, Research Funding; Daiichi Sankyo: Consultancy; TG Therapeutics Inc: Consultancy; Genentech: Consultancy; Blueprint Medicines Corporation: Consultancy; Bantam Pharmaceutical, LLC: Consultancy; MorphoSys AG: Consultancy, Research Funding; Selvita Inc: Consultancy; Debiopharm: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; ADC Therapeutics: Consultancy; F. Hoffmann-La Roche Limited: Consultancy; Zai Laboratory: Consultancy; Constellation Pharmaceuticals: Consultancy. Patterson: Scorpion Therapeutics, Inc.: Ended employment in the past 24 months; Pfizer: Current Employment. Ho: Pfizer Inc.: Current Employment. Rustia: Pfizer Inc (former Seagen Inc employee acquired by Pfizer): Current Employment; Gilead Inc: Ended employment in the past 24 months; Pfizer Inc, Gilead Inc: Current equity holder in publicly-traded company; Seagen Inc: Divested equity in a private or publicly-traded company in the past 24 months. Fanale: Pfizer: Current Employment, Current holder of stock options in a privately-held company; Seagen: Divested equity in a private or publicly-traded company in the past 24 months, Ended employment in the past 24 months. Fenton: Seagen: Ended employment in the past 24 months; Pfizer: Current Employment. Stenner: BMS, Takeda, Roche, Astellas, Pfizer: Honoraria; BMS, Takeda: Research Funding; University Hospital Basel: Current Employment.
OffLabel Disclosure: Brentuximab vedotin is not approved for use in DLBCL. The ECHELON-3 clinical trial is exploring brentuximab vedotin in combination with lenalidomide and rituximab.
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