Brentuximab Vedotin in Early Stage Hodgkin Lymphoma

Prior treatment

• Previous treatment for Hodgkin lymphoma, excluding short courses of oral corticosteroids at a dose of 100mg prednisolone (or equivalent) for up to 7 days
• Any active systemic viral, bacterial or fungal infection requiring systemic antibiotics, antivirals or antifungals within 2 weeks prior to first trial drug dose
• Receiving or recently treated with any other investigational agent (within 4 weeks of trial entry)

Other illness

• Infradiaphragmatic disease
• Other cancer diagnosed with the last 5 years. Patients with completely excised carcinoma in situ of any type and basal or squamous cell carcinoma of the skin are not excluded
• Recurrent or persistent other cancer within last 5 years irrespective of date of initial diagnosis
• History of or current progressive multi-focal leukoencephalopathy or other chronic condition of the brain
• Symptomatic neurologic disease compromising normal activities of daily living or requiring medications
• Infection with HIV, hepatitis C or active hepatitis B infection (surface antigen or DNA positive)
• Known hypersensitivity to recombinant proteins, murine proteins, or to any excipient contained in the drug formulation of brentuximab vedotin or any component of ABVD
• Known history of any cardiovascular or respiratory conditions that would preclude anthracycline or bleomycin administration
• Other significant medical or psychiatric comorbidity that in the opinion of the investigator would make administration of ABVD or A2VD hazardous

Lab values

• Nodular lymphocyte predominant Hodgkin lymphoma

Age

• Age 70 years or over or age 15 years or under

Other

• Absence of FDG-avid lesions on baseline PET scan
• Pre-existing grade ≥1 sensory or motor neuropathy from any cause
• Pregnant or breastfeeding women

• Males and females aged 16-69 years (inclusive) (age range is 18-69 in US and EU)
• Histologically confirmed classical Hodgkin lymphoma
• Stage I or II supradiaphragmatic disease with no mediastinal bulk disease (defined as greater than a third of the transthoracic diameter at any level of thoracic vertebra as determined by CT) or B symptoms. Bulky disease at other sites is acceptable. Extranodal disease (single extranodal site (stage I) or contiguous nodal extension (stage II)) is acceptable.
• ECOG performance status 0-2.
• No previous treatment for Hodgkin lymphoma
• Fit to receive anthracycline-based chemotherapy (patients with a history of ischaemic heart disease or hypertension should have a left ventricular ejection fraction of ≥50%)
• Creatinine clearance (measured or calculated \>40ml/min
• Total bilirubin \<1.5 x upper limit of normal, unless attributable to disease or known Gilbert's syndrome
• ALT or AST \< 2 x upper limit of normal
• Adequate bone marrow function with neutrophils ≥1.0x10\^9/l and platelets ≥100x10\^9/l
• Haemoglobin ≥8g/dL
• Willing and able to comply with the requirements of the protocol, including contraceptive advice, where applicable
• Written informed consent