How might key findings from the HD21 trial influence 1L treatment of advanced stage cHL?

The Lymphoma Hub was pleased to speak to Peter Borchmann, University Hospital Cologne, Cologne, DE. We asked, How might key findings from the HD21 trial influence 1L treatment of advanced stage cHL? 

In this interview, Borchmann discusses results from the randomized, multicenter, phase III HD21 trial (NCT02661503), which evaluated positron emission tomography (PET)-guided brentuximab vedotin + etoposide + cyclophosphamide + doxorubicin + dacarbazine + dexamethasone (BrECADD; n = 751) vs bleomycin + etoposide + doxorubicin + cyclophosphamide + vincristine + procarbazine + prednisolone (eBEACOPP; n = 749) in adults aged ≤60 years with advanced-stage classical Hodgkin lymphoma (cHL).¹ 

Key points 

• A total of 1,500 patients were enrolled in the HD21 trial across nine countries.¹ 
• The co-primary endpoints of the HD21 trial were tolerability, defined by investigator-assessed treatment-related morbidity, and progression-free survival (PFS).¹ 
• BrECADD was better tolerated than eBEACOPP, with ≥1 treatment-related morbidity occurring in 42% vs 59% of patients, respectively (relative risk, 0.72; 95% confidence interval [CI], 0.65–0.80; p < 0.0001).¹ 
• The relative risk of treatment-related morbidity was consistent across all predefined subgroups, including age, gender, stage, and baseline risk.¹ 
• Toxicities had resolved fully or improved to Grade 1 in 96% of patients receiving BrECADD vs 93% of those receiving eBEACOPP at 1 year after treatment.¹ 
• While the primary objective of the HD21 trial was to demonstrate non-inferiority of BrECADD vs eBEACOPP, BrECADD demonstrated superiority vs eBEACOPP in PFS analyses after the non-inferiority criterion was met.¹ 
• The 4-year PFS rates with BrECADD and eBEACOPP were 94.3% (95% CI, 92.6–96.1) and 90.9% (95% CI, 88.7–93.1), respectively (hazard ratio [HR], 0.66; 95% CI, 0.45–0.97; p = 0.035).¹ 
• Results from the 5-year analysis, presented at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition, December 6–9, 2025, Orlando, US, showed that, at a median follow-up of 60 months, PFS rates remained higher with BrECADD vs eBEACOPP (93.6% vs 90.6%; HR, 0.64; 95% CI, 0.44–0.93).² 
• Results from the HD21 trial establish PET-guided BrECADD as an effective and more tolerable alternative to eBEACOPP, supporting its transition into standard of care for adults with advanced-stage cHL.^1,2  

This educational resource is independently supported by Takeda. All content is developed by SES in collaboration with an expert steering committee. Funders are allowed no influence.