Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial

Engert, Andreas; Haverkamp, Heinz; Kobe, Carsten; Marková, Jana; Renner, Christoph; Ho, A. D.; Zijlstra, Josée M.; Král, Zdeněk; Fuchs, Michael; Hallek, Michael; Kanz, Lothar; Döhner, Hartmut; Dörken, Bernd; Engel, Nicole; Topp, Max S.; Klutmann, Susanne; Amthauer, Holger; Bockisch, Andreas; Kluge, Regine; Kratochwil, Clemens; Schober, Otmar; Greil, Richard; Andreesen, Reinhard; Kneba, Michael; Pfreundschuh, Michael; Stein, Harald; Eich, Hans Theodor; Müller, Rolf-Peter; Dietlein, Markus; Borchmann, Peter; Diehl, Volker

doi:10.1016/s0140-6736(11)61940-5

Cited by 574 publications

(368 citation statements)

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“…PETnegative patients received no additional RT. 67 Of the 739 qualified patients with residual disease (≥2.5 cm) after 6 to 8 cycles of BEACOPP, 548 (74%) were PET-negative; 191 patients (26%) were PET-positive and received consolidative RT. The final analysis showed that the prognosis of patients in PR with PET-negative persistent residual disease after chemotherapy was similar to that of those who were in CR as measured by conventional CT (4-year PFS was 92.1%), suggesting that consolidative RT could be omitted in patients with a PET-negative PR.…”

Section: Stage Iii-ivmentioning

confidence: 99%

“…58,64,67 The landmark randomized trial by the CALBG showed that ABVD alone or alternating with MOPP was superior to MOPP alone in patients with newly diagnosed advanced HL (stage III-IV). 68 ABVD also was less myelotoxic than MOPP or ABVD alternating with MOPP, and has since been the standard treatment for patients with stage III-IV disease.…”

Section: Stage Iii-ivmentioning

confidence: 99%

“…The 5-year OS rate, however, was not different (92% and 90.3%, respectively). 71 The final analysis of the HD15 trial reported by Engert et al 67 showed that 6 cycles of escalated-dose BEACOPP followed by PET-guided RT resulted in significantly superior OS and tumor control than 8 cycles of escalated-dose BEACOPP in patients with advanced-stage disease (stage IIB with large mediastinal mass or stage III-IV). In this study, 2,182 patients were randomly assigned to 1 of the 3 treatment groups: 8 cycles of escalated-dose BEACOPP (n=728), 6 cycles of escalated-dose BEACOPP (n=726), or 8 cycles of a time-intensified standarddose BEACOPP (n=728).…”

Section: Stage Iii-ivmentioning

confidence: 99%

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Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

Hoppe¹,

Advani²,

Ai³

et al. 2017

J Natl Compr Canc Netw

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OverviewHodgkin lymphoma (HL) is an uncommon malignancy involving lymph nodes and the lymphatic system. Most patients are diagnosed between 15 and 30 years of age, followed by another peak in adults aged ≥55 years. In 2017, an estimated 8,260 people will be diagnosed with HL in the United States and 1,070 will die of the disease. AbstractThis portion of the NCCN Guidelines for Hodgkin lymphoma (HL) focuses on the management of classical HL. Current management of classical HL involves initial treatment with chemotherapy or combined modality therapy followed by restaging with PET/CT to assess treatment response using the Deauville criteria (5-point scale). The introduction of less toxic and more effective regimens has significantly advanced HL cure rates. However, long-term follow-up after completion of treatment is essential to determine potential long-term effects. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Section: Stage Iii-ivmentioning

confidence: 99%

Section: Stage Iii-ivmentioning

confidence: 99%

Section: Stage Iii-ivmentioning

confidence: 99%

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Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

Hoppe¹,

Advani²,

Ai³

et al. 2017

J Natl Compr Canc Netw

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“…The randomized GHSG HD15 trial aimed at reducing treatment toxicity without compromising efficacy [16]. Chemotherapy within this trial consisted of eight cycles of BEACOPP escalated , six cycles of BEACOPP escalated or eight cycles of BEACOPP-14, a time-dense variant of the BEACOPP baseline protocol.…”

Section: Treatment Of Advanced Stagesmentioning

confidence: 99%

Advances in the treatment of Hodgkin lymphoma

Eichenauer

Engert

2012

Int J Hematol

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In the past decades, Hodgkin lymphoma (HL) has turned from an incurable disease to one with the most favorable prognosis among adult malignancies. This is due to the introduction of effective multi-agent chemotherapy and the optimization of radiation techniques. At present, 80-90 % of patients achieve long-term remission when receiving appropriate first-line treatment. Even in case of relapse, up to 50 % can be successfully salvaged with highdose chemotherapy and autologous stem cell transplantation. Thus, current studies do not necessarily aim at increasing treatment efficacy but rather focus on a possible reduction of acute and late toxicity by decreasing treatment intensity if possible. One promising strategy to spare therapy in good-risk patients is early response-adapted treatment stratification according to the result of interim positron emission tomography. The evaluation of novel drugs and the optimization of treatment for elderly HL patients and those with nodular lymphocyte-predominant HL are further aspects that are currently being addressed in ongoing trials. This review will give an overview on more recent clinical trials and discuss possible future strategies for the treatment of HL.

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“…In the broader sense, the use of 18 F-fluorodeoxyglucose (FDG) PET/CT in oncology is a form of theranostics, especially when linked to a decision on therapy. This is especially evident in, for example, modern protocols for the treatment of lymphoma, where the decision on additional treatment with, for example, external beam radiotherapy (EBRT) depends on whether FDG-positive lesions are still present after a number of chemotherapy cycles [22]. In modern EBRT, PET/CT using various tracers such as FDG or 18 F-fluoroethyltyrosine is also a clear diagnostic test which is linked to a specific therapy, as modern radiotherapy approaches use PET/CT for planning the extent of EBRT, as well as to determine where an additional radiation boost needs to be applied in intensity-modulated radiotherapy [23].…”

mentioning

confidence: 99%