Should Response-Adapted Therapy Now Be the Standard of Care for Advanced Hodgkin’s Lymphoma?

Purpose In this multicenter, prospective, randomized clinical trial on advanced Hodgkin's lymphoma (HL), the efficacy and toxicity of two chemotherapy regimens, doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone (Stanford V) and mechlorethamine, vincristine, procarbazine, prednisone, epidoxirubicin, bleomycin, vinblastine, lomustine, doxorubicin, and vindesine (MOPPEBVCAD), were compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as standard therapy to select which regimen would best support a reduced radiotherapy program, which was limited to ≤ two sites of either previous bulky or partially remitting disease (a modification of the original Stanford program). Patients and Methods Three hundred fifty-five patients with stage IIB, III, or IV HL were randomly assigned. Three hundred thirty-four patients were assessable for the study and received six cycles of ABVD (n = 122), three cycles of Stanford V (n = 107), or six cycles of MOPPEBVCAD (n = 106); radiotherapy was administered to 76, 71, and 50 patients in these three arms, respectively. Results The complete response rates for ABVD, Stanford V, and MOPPEBVCAD were 89%, 76% and 94%, respectively; 5-year failure-free survival (FFS) and progression-free survival rates were 78%, 54%, 81% and 85%, 73%, and 94%, respectively (P < .01 for comparison of Stanford V with the other two regimens). Corresponding 5-year overall survival rates were 90%, 82%, and 89% for ABVD, Stanford V, and MOPPEBVCAD, respectively. Stanford V was more myelotoxic than ABVD but less myelotoxic than MOPPEBVCAD, which had larger reductions in the prescribed drug doses. Conclusion When associated with conditioned and limited (not adjuvant) radiotherapy, ABVD and MOPPEBVCAD were superior to Stanford V chemotherapy in terms of response rate and FFS and progression-free survival. Patients were irradiated less often after MOPPEBVCAD, but this regimen was more toxic. ABVD is still the best choice when it is combined with optional, limited irradiation.

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A weekly regimen with dose escalation of doxorubicin for patients with advanced Hodgkin's lymphoma: Results of a phase II study of the Groupe d'Études des Lymphomes de l'Adulte (GELA)

Leukemia & Lymphoma ◽

10.1080/10428190601175369 ◽

2007 ◽

Vol 48 (4) ◽

pp. 691-698 ◽

Cited By ~ 3

Author(s):

Christophe Fermé ◽

Pauline Brice ◽

Anne-Sophie Michallet ◽

Pierre Lederlin ◽

Marine Diviné ◽

...

Keyword(s):

Phase Ii ◽

Dose Escalation ◽

Hodgkin’S Lymphoma ◽

Phase Ii Study ◽

Hodgkin's Lymphoma ◽

Advanced Hodgkin’S Lymphoma

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The Role of Radiotherapy in Hodgkin’s Lymphoma: What Has Been Achieved during the Last 50 Years?

BioMed Research International ◽

10.1155/2015/485071 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Magdalena Witkowska ◽

Agata Majchrzak ◽

Piotr Smolewski

Keyword(s):

Radiation Therapy ◽

Safety Profile ◽

Hodgkin’S Lymphoma ◽

Antitumor Agents ◽

Standard Of Care ◽

Hodgkin's Lymphoma ◽

Field Size ◽

Field Radiation ◽

Involved Field

Currently, Hodgkin’s lymphoma (HL) has an excellent clinical outcome, with overall survival of approximately 90% in early stages of the disease. Based on young age of the majority of patients at the time of diagnosis and their long survival time, increased attention has been focused on long-term toxicity of therapy. While novel, directly targeting antitumor agents, with an excellent safety profile, have been developed for HL treatment, the role of radiotherapy is still debated. Radiotherapy may induce cardiovascular disease and impairment of thyroid or pulmonary function and, most importantly, may lead to development of secondary cancers. As a consequence, the current radiation therapy planning paradigm is mainly focused on a reduction of field size. As it was investigated in clinical trials regional therapy is as effective as extended field radiotherapy, but less toxic. Although chemotherapy is the mainstay of HL treatment, consolidative involved field radiation therapy is still considered to be the standard of care in both early and advanced stages. Recently, further field reduction has been investigated to further decrease the late radiation-induced toxicity. In this paper we describe the role and safety profile of radiotherapy in the past and present and hope for the novel techniques in the future.

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The Revised High-Dose Regimen of Beacop in the Primary Treatment of the Advanced Hodgkin's Lymphoma: A Interim Report

Blood ◽

10.1182/blood.v120.21.4783.4783 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4783-4783

Author(s):

Peng LIU ◽

Yuankai Shi ◽

Zhao Wang

Keyword(s):

Hodgkin’S Lymphoma ◽

Standard Dose ◽

Primary Treatment ◽

Hodgkin's Lymphoma ◽

High Dose ◽

Similar Response ◽

Good Tolerance ◽

Asian Patients ◽

Advanced Hodgkin’S Lymphoma

Abstract Abstract 4783 Objective In the study, we compared the efficacy between the revised high-dose and standard-dose of the revised BEACOP regimen (Bleomycin, Etoposide, Epidoxorubicin, Cyclophophamide, Vincristine, Prednisione) in the treatment of the advanced Hodgkin's lymphoma (HL). Patients and methods Patients with HL of Stage III/IV were 1:1 randomized into either the standard-dose BEACOP regimen (the same to the BEACOPP regimen in GHSG-HD9 study except procarbazine) in the control arm or the revised high-dose BEACOP regimen (different from BEACOPPesc regimen in GHSG-HD9 study, excluding procarbazine, increasing the dose of cyclophophamide and doxorubicin, with the standard-dose of etoposide, and without the preventive G-CSF support) in the experimental arm. Patients with large tumor or residual tumor after 6 to 8 cycles chemotherapy would be received local radiotherapy. All patients were evaluated by imaging examination every 2 cycles during treatment and were followed up every 3 months from the end of the treatment. Results 33 cases with advanced HL completed whole cycles chemotherapy and were followed-up a medium time of 12 months. The interim analysis showed that, patients received revised high-dose BEACOP had better response than those with standard-dose BEACOP. After 2 cycles chemotherapy, 2/17 cases had complete response (CR), and 8/17 cases had reduced more than 75% in the tumor size in the experimental arm; while none of 16 cases in the control arm achieved the similar response. After 6 cycles chemotherapy, 13/17 cases in the experimental arm achieved CR/CRu, compared with 8/16 cases in the control arm. Simultaneously, adverse drug reactions, such as neutropenia, nausea and vomiting, were observed significantly increased in the experimental arm. However, no related death and SAE occurred. All the patients showed good tolerance in the study. Conclusions In the HD9 study, asian patients received with BEACOPPesc were not tolerated enough to complete the whole chemotherapy, because of the serious toxicity such as long-term bone marrow suppression. In our study, we demonstrated that revised high-dose BEACOP in the primary treatment of the advanced HL would achieved the more high rate of CR/CRu compared with standard-dose BEACOP, and patients with revised high-dose BEACOP showed good tolerance and controllable acute hematotoxicity, even without the preventive use of G-CSF. Therefore, the revised high-dose BEACOP regimen might be a potential choice for Asian patients with advanced HL. However, more cases and long-term follow-up should be needed in the future to evaluate the long-term overall survival (OS) rate, efficacy and toxicity. Disclosures: LIU: Research Project of Cancer Hospital, CAMS: Research Funding.

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