Patients with Unfavorable Hodgkin’s Lymphoma May Not Benefit from More Therapy

Patients with Unfavorable Risk Hodgkin’s Lymphoma May Not Benefit from More Intensive Therapy

Researchers from Germanyhave reported that more intensive chemotherapy and increased dose of radiation therapy did not benefit patients with unfavorable Hodgkin’s lymphoma.[1] Another study, from the European Organization for Research and Treatment of Cancer (EORTC) also failed to show a benefit of six versus four cycles of chemotherapy.[2] These two studies were presented at the 47th Annual Meeting of the American Society of Hematology in Atlanta in December of 2005.

Hodgkin’s lymphoma is a cancer of the lymph system. It is diagnosed when a characteristic cell (the Reed- Sternberg cell) is identified under a microscope. Hodgkin’s lymphoma typically begins in the lymph nodes in one region of the body and then spreads through the lymph system in a predictable manner. It may spread outside the lymph system to other organs such as the lungs, liver, bone, and bone marrow.

Stage I and stage II Hodgkin’s lymphomas are sometimes further classified as “favorable” or “unfavorable” based on prognostic factors such as age, lab and pathology results, symptoms, and number of involved sites. Patients with early-stage, unfavorable Hodgkin’s lymphoma are usually treated with a combination of chemotherapy and radiation therapy. Despite treatment, however, many patients have a recurrence of disease. Furthermore, heavily treated patients may have side effects such as second cancers.

ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) is the most commonly used chemotherapy regimen for Hodgkin’s lymphoma. BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) is a more intensive regimen that has also been evaluated, but not clearly shown to be superior to ABVD. The optimal dose of radiation therapy is also being re-evaluated in several clinical studies.

To evaluate different chemotherapy regimens and different doses of radiation therapy in the treatment of Hodgkin’s lymphoma, researchers in Germany conducted a clinical trial among 1570 patients with untreated intermediate-stage Hodgkin’s lymphoma. Patients were randomly assigned to receive one of four treatment regimens:

  1. 4 cycles of ABVD plus 30 Gy of radiation therapy (standard treatment)
  2. 4 cycles of ABVD plus 20 Gy of radiation therapy
  3. 4 cycles of BEACOPP plus 30 Gy of radiation therapy
  4. 4 cycles of BEACOPP plus 20 Gy of radiation therapy

After three years of follow-up, 87% of patients had survived without treatment failure; overall survival was 96%. There were no differences across treatment groups in treatment toxicity or probability of recurrence.

The EORTC trial enrolled 803 patients with stage I or stage II Hodgkin’s lymphoma. Patients were randomly assigned to receive one of three treatment regimens:

  1. 6 cycles of ABVD plus 36-40 Gy of radiation therapy
  2. 4 cycles of ABVD plus 36-40 Gy of radiation therapy
  3. 4 cycles of BEACOPP plus 36-40 Gy of radiation therapy

After four years of follow-up, the following proportions of patients survived without treatment failure: 91%, 87%, and 90%, across the three treatments. Overall survival rates were 95%, 94%, and 93%, respectively.

Based on these two trials, it would appear that ABVD remains the treatment of choice for stage I and stage II Hodgkin’s lymphoma. These data also suggest that increased doses of radiation therapy may not be necessary.

References:

[1] Diehl V, Brillant C, Engert A, et al. Recent interim analysis of the HD11 trial of the GHSG; Intensification of chemotherapy and reduction of radiation dose in early unfavorable stage Hodgkin’s lymphoma. Blood.2005;106:240a, abstract number 816.

[2] Ferme C, Divine M, Vronsky A, et al. Four ABVD and involved-field radiotherapy in unfavorable supradiaphragmatic clinic al stages (CS) I-II Hodgkin’s lymphoma (HL): Preliminary results of the EORTC-GELA H9-U Trial. Blood. 2005;106:240a, abstract number 813.

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