Long-term follow-up data from multiple studies support the current risk-adapted therapeutic strategies in early-stage Hodgkin lymphoma, according to research published in the Journal of Clinical Oncology (published online April 18, 2017; doi:10.1200/JCO.2016.70.9410).
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In patients with early-stage Hodgkin lymphoma, combined-modality treatment is considered standard of care because it offers better tumor control than radiotherapy. However, treatment-related morbidities – such as second neoplasias and organ toxicity – may have a negative effect on long-term survival outcomes. Treatment intensity has been reduced in recent trials to test whether long-term efficacy and safety are improved for the different therapies.
Andreas Engert, MD, professor of internal medicine, hematology and oncology, University Hospital of Cologne (Germany), and colleagues analyzed updated follow-up data on 4276 patients treated in the German Hodgkin Study Group, which housed 4 trials for patients with Hodgkin lymphoma. Trials HD7 and HD10 sampled patients with early-stage, favorable Hodgkin lymphoma, whereas trials HD8 and HD11 sampled patients with early-stage, unfavorable Hodgkin lymphoma.
In HD7, combined-modality treatment proved superior to extended-field radiotherapy, with a 15-year progression-free survival (PFS) of 73% vs 52% (HR, 0.5; 95% CI, 0.3-0.6; P < .001) and no significant difference in overall survival (OS). In HD10, noninferiority of 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) plus involved-field radiotherapy (20 Gy) was confirmed in comparison to more intensive 4 cycles of ABVD plus radiotherapy (30 Gy), with a 10-year PFS of 87% each (HR, 1.0; 95%, 0.6 to 1.5) and OS of 94% each (HR, 0.9; 95% CI, 0.5 to 1.6).
In both trials, no differences in second neoplasias were reported.
In HD8, noninferiority of involved-field radiotherapy to extended-field radiotherapy was confirmed in regards to PFS (HR, 1.0; 95% CI, 0.8 to 1.2). In HD11, superiority of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) at baseline over ABVD was not observed; involved-field radiotherapy (20 Gy) was noninferior to radiotherapy (30 Gy) (10-year PFS, 84% v 84%; HR, 1.0; 95% CI, 0.7 to 1.5).
In both trials, no differences in OS or second neoplasias were reported.
“The risk of second neoplasias is being addressed by reducing both radiotherapy field size and dose,” said Dr Engert in a press release (April 26, 2017).
Researchers concluded that these findings support the current risk-adapted therapies for early-stage Hodgkin lymphoma. However, long-term safety of such strategies still needs to be validated. – Zachary Bessette
