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

Study Overview
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Brief Summary
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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.

Official Title
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A Pilot Study of Brentuximab Vedotin Combined With AVD Chemotherapy in Patients With Newly Diagnosed Early Stage, Unfavorable Risk Hodgkin Lymphoma

Conditions
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Hodgkin Lymphoma

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


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cohort 1 (completed accrual)<br>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. | Drug: Brentuximab vedotin (SGN-35)<br> <br> Drug: Doxorubicin HCL<br> <br> Drug: Vinblastine Sulfate<br> <br> Drug: Dacarbazine<br> <br> Radiation: Involved-Site Radiation Therapy (ISRT)<br> <br> Procedure: Interim PET<br> <br> |
| Experimental: Cohort 2<br>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. | Drug: Brentuximab vedotin (SGN-35)<br> <br> Drug: Doxorubicin HCL<br> <br> Drug: Vinblastine Sulfate<br> <br> Drug: Dacarbazine<br> <br> Radiation: Involved-Site Radiation Therapy (ISRT)<br> <br> Procedure: Interim PET<br> <br> |
| Experimental: Cohort 3<br>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. | Drug: Brentuximab vedotin (SGN-35)<br> <br> Drug: Doxorubicin HCL<br> <br> Drug: Vinblastine Sulfate<br> <br> Drug: Dacarbazine<br> <br> Procedure: Interim PET<br> <br> Radiation: consolidation volume RT (CVRT)<br> <br> |
| Experimental: Cohort 4<br>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. | Drug: Brentuximab vedotin (SGN-35)<br> <br> Drug: Doxorubicin HCL<br> <br> Drug: Vinblastine Sulfate<br> <br> Drug: Dacarbazine<br> <br> Procedure: Interim PET<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| development of significant pulmonary toxicity | specifically non-infectious pneumonitis The definition of unacceptable pulmonary toxicity will be defined as the development of grade 2 or higher pneumonitis as defined by Common Terminology Criteria for Adverse Events (CTCAE version 4). | 1 year | 
| complete responses (all cohorts) | Evaluate the rate of PET-negative complete responses after completion of the treatment program (8 weeks (+/- 2 weeks) after completion of radiotherapy). | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluate the prognostic significance | (i.e. correlation with progression free survival) of interim fluorodeoxyglucose-positron emission tomography (PET) in this patient population measured by visual analysis and semi-quantitative analysis. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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DACARBAZINE, DOXORUBICIN/ADRIAMYCIN, SGN-35 (BRENTUXIMAB VEDOTIN), VINBLASTINE, Involved-site radiation therapy (ISRT), Early stage, 13-034