A Matching-Adjusted Indirect Comparison of PET-Guided BrECADD Versus PET-Guided ABVD, BEACOPP, and eBEACOPP in Advanced Hodgkin Lymphoma

INTRODUCTION: In the absence of head-to-head trial data, a matching-adjusted indirect comparison (MAIC) was conducted to compare the effectiveness, with respect to overall survival (OS) and progression-free survival (PFS), of PET-guided BrECADD versus PET-guided ABVD, BEACOPP, and eBEACOPP in advanced Hodgkin lymphoma. METHODS: Individual patient data (IPD) from patients in HD21 and aggregate data from the SWOG S0816, RATHL, HD9, and Mondello 2020 studies were utilized. Potential effect modifiers and prognostic variables for advanced Hodgkin lymphoma were identified via literature review, clinician input, and statistical analysis. As there was no common arm between HD21 and the comparator trials, unanchored MAICs were conducted. Data from patients in HD21 were weighted to align with published aggregate characteristics of the comparator trials. RESULTS: BrECADD was associated with significantly improved PFS and OS compared with PET-guided ABVD among patients aged 18-60 (SWOG S0816; PFS HR: 0.24, 95% CI 0.16, 0.35, p < 0.001; OS HR: 0.30, 95% CI 0.14, 0.63, p = 0.004) and patients aged 18 to 75 (RATHL; PFS HR: 0.24, 95% CI 0.16, 0.36, p < 0.001; OS HR: 0.47, 95% CI 0.25, 0.89, p = 0.01). In the comparison of BrECADD versus BEACOPP (per the Mondello et al. 2020 study cohort), there was a trend in PFS improvement [HR = 0.58 (95% CI 0.29, 1.19), p = 0.194)] in favor of BrECADD in adults aged 18-75 years of age. Additionally, a trend was observed among patients aged 66-75, favoring BrECADD for freedom from treatment failure [HR = 0.63 (95% CI 0.28, 1.44), p = 0.260] when compared to BEACOPP (HD9). CONCLUSION: These findings provide robust evidence and further support for the use of BrECADD in adult patients with advanced Hodgkin lymphoma.