SWOG S1826 3-year follow-up: N-AVD vs BV-AVD in adolescents with AS cHL

Three-year follow-up results from a subset analysis of the randomized, phase III SWOG S1826 trial (NCT03907488), comparing nivolumab + doxorubicin + vinblastine + dacarbazine (N-AVD) vs brentuximab vedotin + doxorubicin + vinblastine + dacarbazine (BV-AVD) in adolescents with newly diagnosed (ND) advanced-stage (AS; stages III–IV) classic Hodgkin lymphoma (cHL), were published in the Journal of Clinical Oncology by Castellino et al. Of 994 patients from the SWOG S1826 trial, 240 were aged 12–17 years; data on 236 eligible patients are reported (n = 118 per arm). The primary endpoint was progression-free survival (PFS) at a data cutoff of July 1, 2025. Secondary endpoints included adverse events (AEs), event-free survival (EFS), overall survival (OS), and patient-reported toxicity. 

Key data: At a median follow-up of 3.1 years, 3-year PFS was higher with N-AVD vs BV-AVD (93% vs 82%; hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.17–0.80; one-sided p = 0.004). The rates of 3-year EFS were 89% with N-AVD vs 80% for BV-AVD (HR, 0.55; 95% CI, 0.29–1.06; one-sided p = 0.035), while 3-year OS was 100% vs 99%. Grade ≥3 neutropenia occurred in 45% vs 42% of patients receiving N-AVD and BV-AVD, respectively, while reports of febrile neutropenia (3% each) and sepsis (1% each) remained low. Grade ≥2 sensory neuropathy was less frequent with N-AVD vs BV-AVD (7% vs 14%), and immune-related AEs were infrequent. Thyroid dysfunction was more frequent with N-AVD (hypothyroid, 5%; hyperthyroid, 2%) vs BV-AVD (hypothyroid, 1%). Patient-reported outcomes suggested less toxicity with N-AVD.

Key learning: N-AVD demonstrated superior 3-year PFS vs BV-AVD, alongside a manageable safety profile, supporting its consideration as a first-line treatment option in adolescents with AS cHL.