Dose escalation does not significantly improve outcome in some Hodgkin's patients, according to the results of a recent study by the German Hodgkin Study Group (GHSG).
The GHSG's HD11 trial examined whether the standard of care for patients with early unfavorable Hodgkin's lymphoma could be improved with a more intensive chemotherapy regimen.
The GHSG defines early-stage unfavorable HL as being either stage I or II with the following characteristics:
--- Erythrocyte sedimentation rate of 50 or higher if asymptomatic (A), 30 or higher if symptomatic (B)
--- MMR greater than .33
--- More than 2 extranodal sites
--- The presence of any E lesions
The trial, with 1,395 patients, pitted the standard treatment for this group of 4-6 cycles of ABVD combination chemotherapy plus involved-field radiotherapy (IFRT) against 4 cycles of BEACOPP plus IFRT. An additional two arms featured the same amount of chemotherapy but lowered the radiation dose from 30 Gy to 20 Gy.
Although outcomes were very similar, the group concluded that moderate dose escalation in the form of BEACOPP "did not significantly improve outcome in early unfavorable HL", and that the current standard, 4 cycles of ABVD followed by 30 Gy of IFRT, should remain the standard.
CANCER TYPE(S)
Hodgkin's lymphoma
TREATMENT TYPE(S)
Combination chemotherapy and involved field radiotherapy
WHERE WAS THIS STUDY PUBLISHED?
Journal of Clinical Oncology
Source
JCO
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