Treatment of Early-Stage Hodgkin's Lymphoma: Less Proves More
Hello. I'm Bruce Cheson of Georgetown University Hospital and the Lombardi Comprehensive Cancer Center. Today's Medscape discussion will be about Hodgkin's lymphoma, which is one of the success stories of modern oncology. We cure 60%-95% of patients, depending on the stage and the risk category. What we face now are not as much the long-term relapses but the complications of our treatment that the patients face down the road.
What we are trying to do is to maintain efficacy and reduce toxicities, particularly secondary malignancies. Towards this end, the German Hodgkin's Study Group published a paper in the August 12, 2010 issue of The New England Journal of Medicine that really merits attention. In this study, they took 1370 patients with early stage disease. Now, no one can do a study like this except the German Hodgkin's Study Group. They accrue enormous numbers of patients to high-quality studies, and they randomize these patients in the 2-by-2 kind of design. They either have 4 vs 2 cycles of ABVD for their limited-stage disease and either 30 Gy or 20 Gy of involved-field radiation.
The results were interesting, important, and impressive. What they found was there was no difference between 4 cycles and 2, except for the increased toxicity with 4 cycles, and similarly there was no difference between 30 and 20 Gy except for adverse effects. The time to treatment failure across the arms was well over 90%, demonstrating that, in this patient population, 2 cycles of ABVD and 20 Gy of radiation is what they consider the standard therapy. The arm that was missing from this study is no radiation. If less is as good as more, maybe none is as good as less. There are now a series of US and international studies looking at this question, using risk-adapted strategies, doing a PET scan after 1 or 2 or 3 cycles of therapy depending on the trial, and basing the next step on the results of the PET scan. If the scan is negative, then they are continuing with what would be the standard treatment or perhaps an abbreviated version thereof -- instead of 6 cycles maybe 4, maybe 3. If the PET is positive, they are changing therapy to something such as escalated BEACOPP chemotherapy.
These studies are critically important to tell us how we can reduce toxicities in patients with low-risk disease and improve the outcome in patients who have adverse features, particularly a positive PET scan. Interesting study, major potential of implications.
Thank you for your attention, and I hope that this information was useful to you. This is Bruce Cheson signing off.
Hello. I'm Bruce Cheson of Georgetown University Hospital and the Lombardi Comprehensive Cancer Center. Today's Medscape discussion will be about Hodgkin's lymphoma, which is one of the success stories of modern oncology. We cure 60%-95% of patients, depending on the stage and the risk category. What we face now are not as much the long-term relapses but the complications of our treatment that the patients face down the road.
What we are trying to do is to maintain efficacy and reduce toxicities, particularly secondary malignancies. Towards this end, the German Hodgkin's Study Group published a paper in the August 12, 2010 issue of The New England Journal of Medicine that really merits attention. In this study, they took 1370 patients with early stage disease. Now, no one can do a study like this except the German Hodgkin's Study Group. They accrue enormous numbers of patients to high-quality studies, and they randomize these patients in the 2-by-2 kind of design. They either have 4 vs 2 cycles of ABVD for their limited-stage disease and either 30 Gy or 20 Gy of involved-field radiation.
The results were interesting, important, and impressive. What they found was there was no difference between 4 cycles and 2, except for the increased toxicity with 4 cycles, and similarly there was no difference between 30 and 20 Gy except for adverse effects. The time to treatment failure across the arms was well over 90%, demonstrating that, in this patient population, 2 cycles of ABVD and 20 Gy of radiation is what they consider the standard therapy. The arm that was missing from this study is no radiation. If less is as good as more, maybe none is as good as less. There are now a series of US and international studies looking at this question, using risk-adapted strategies, doing a PET scan after 1 or 2 or 3 cycles of therapy depending on the trial, and basing the next step on the results of the PET scan. If the scan is negative, then they are continuing with what would be the standard treatment or perhaps an abbreviated version thereof -- instead of 6 cycles maybe 4, maybe 3. If the PET is positive, they are changing therapy to something such as escalated BEACOPP chemotherapy.
These studies are critically important to tell us how we can reduce toxicities in patients with low-risk disease and improve the outcome in patients who have adverse features, particularly a positive PET scan. Interesting study, major potential of implications.
Thank you for your attention, and I hope that this information was useful to you. This is Bruce Cheson signing off.