ECHELON-1
Swapping bleomycin for the CD30 ADC in first-line chemotherapy improved survival in advanced Hodgkin lymphoma, the first frontline survival gain in decades.
Modified PFS HR 0.77 at 2 years; 6-year OS 93.9% vs 89.4% (HR 0.59, NEJM 2022). More neuropathy and neutropenia (G-CSF now recommended), less pulmonary toxicity. Approved March 2018.
- 82.1 vs 77.2 out of 100 alive without the cancer growing at 2 years with BV-AVD compared with ABVD; 4.9 more per 100.
- Roughly one extra person helped for every 20 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- Put another way, the treated group had about 23 percent lower chance of the event at any given time (hazard ratio 0.77, likely range 0.6 to 0.98).
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- 93.9 vs 89.4 out of 100 alive at 6 years with BV-AVD compared with ABVD; 4.5 more per 100.
- Roughly one extra person helped for every 22 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- Put another way, the treated group had about 41 percent lower chance of the event at any given time (hazard ratio 0.59, likely range 0.4 to 0.88).
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Untreated stage III-IV classical Hodgkin lymphoma: brentuximab vedotin + AVD vs ABVD. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,334 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 6 years | BV-AVD | 664 | 93.9% | 0.59 (0.4–0.88) | 0.009 | link |
| ABVD | 670 | 89.4% | ||||
| Modified PFS at 2 yearsprimary | BV-AVD | — | 82.1% | 0.77 (0.6–0.98) | — | link |
| ABVD | — | 77.2% |
S1826 moved checkpoint blockade into first-line Hodgkin lymphoma and made N-AVD a preferred regimen for advanced disease in patients from adolescence to older age, while removing radiotherapy for most. It also showed the value of a single trial spanning paediatric and adult groups. Longer follow-up is needed for overall survival and late immune effects in young patients.
ECHELON-1 made a targeted antibody-drug conjugate part of first-line Hodgkin therapy and eventually showed that this saves lives, not just relapses. It set the reference arm against which nivolumab-AVD (SWOG S1826) and BrECADD (HD21) were later compared. Neuropathy is the main price and needs proactive dose modification.