Incidence of clinically significant chemotherapy induced nausea and vomiting with brentuximab vedotin and AVD in comparison with ABVD using standard anti-emetic prophylaxis.

Chemotherapy-induced nausea and vomiting (CINV) is an important side effect of the ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and BV-AVD (brentuximab, vedotin, doxorubicin, vinblastine, dacarbazine) regimens for classical Hodgkin lymphoma (cHL). The same anti-emetic prophylaxis strategies are commonly used for both; however, the comparative incidence of CINV between regimens is not well described. We conducted a retrospective cohort study of cHL patients treated with ABVD (n = 87) or BV-AVD (n = 57) given standard anti-emetic prophylaxis with dexamethasone and palonosetron or ondansetron. Clinically significant nausea was more frequent in the BV-AVD cohort (44% vs 20%, p < 0.01), alongside higher rates of hospitalization or emergency department visits for CINV (18% vs 2.3%, p < 0.01) and significant weight loss (40% vs 7.0%, p < 0.0001). Multivariable analysis showed BV-AVD treatment was the only variable independently associated with clinically significant CINV. These findings suggest BV-AVD is more emetogenic than ABVD and that two drug anti-emetic prophylaxis is suboptimal for AVD-based regimens.