Sequential chemotherapy (etoposide, vinblastine, and doxorubicin) and subtotal lymph node radiation for patients with localized hodgkin disease and unfavorable prognostic features

Wasserman, Todd H.; Petroni, Gina R.; Millard, Frederick E.; Chung, Chung-Taik; Barcos, Maurice; Johnson, Jackie; Canellos, George P.; Peterson, Bruce A.

doi:10.1002/(sici)1097-0142(19991015)86:8<1590::aid-cncr29>3.0.co;2-4

Cited by 12 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indirect evidence supporting the presence of two different prognostic subgroups also comes from other studies. 2,3 To summarize, dividing the early stages into two distinct subgroups is strongly supported by these data.…”

Section: Should One Distinguish Between Early Favorable and Early Unfmentioning

confidence: 56%

“…7,9 Since the effective dose (ED), according to the Hasenclever-score of BEACOPP baseline, is only very moderately increased compared with ABVD (15 to 15.2), the GHSG follow-up trial for early unfavorable patients, HD14, compared four cycles of ABVD with two cycles of escalated BEACOPP, followed by two cycles of ABVD ("2 ϩ 2," ED 17.3), followed by IFRT. 3,10 The third preplanned interim analysis of this trial demonstrated a significantly better PFS for the more intensive "2 ϩ 2" arm at 3 years ("2 ϩ 2": 97%; ABVD: 91%, P Ͻ .0017). 11 Upfront intensification with only two cycles of escalated BEACOPP improves outcome in this group of patients; however, one can argue about clinical relevance of an absolute improvement in PFS of 6% in the face of the putative increased toxicity (eg, gonadal damage and secondary malignancies).…”

Section: Treatment Of Early Unfavorable Hlmentioning

confidence: 87%

See 1 more Smart Citation

The Past: What We Have Learned in the Last Decade

Borchmann

Engert

2010

Hematology

View full text Add to dashboard Cite

Hodgkin lymphoma (HL) has become a curable malignancy for most patients during the last decades. However, many controversies still exist on the optimal strategy of how to cure our patients. The key question is how to balance the risks and toxicities of chemotherapy and radiotherapy against the need for a definite treatment for early or advanced-stage HL patients. However, although many studies have been conducted and reported during the past decade, interpretation of their results and treatment recommendations might vary significantly in different countries. For example, early-stage HL might be divided into two different subgroups: early favorable and early unfavorable or not. Treatment of early-stage HL might include radiotherapy ("combined modality") or not. Depending on the extent of radiotherapy, the schedule and number of chemotherapy cycles are also questioned. For advanced-stage HL, the situation is not much different. Compared with ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine), the more aggressive escalated BEACOPP regimen (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) is highly effective, but also raises concern due to excessive toxicity. Thus, there is a controversy about the standard of care for advanced HL patients. Because no mature results comparing these approaches with each other are currently available, it remains our duty to share the preliminary information with our patients and to figure out the most appropriate individual treatment strategy. Of course, the discussion of these issues is influenced by experiences and preferences. In contrast, in this article, we will try to focus on the available scientific evidence regarding the first-line treatment of HL. Of course, focusing on the last decade necessarily exclude the most recent results from ongoing studies. Thus, even though this article comprises treatment recommendations for HL patients, the best treatment certainly still is within properly designed prospective clinical trials.

show abstract

Section: Should One Distinguish Between Early Favorable and Early Unfmentioning

confidence: 56%

Section: Treatment Of Early Unfavorable Hlmentioning

confidence: 87%

The Past: What We Have Learned in the Last Decade

Borchmann

Engert

2010

Hematology

View full text Add to dashboard Cite

show abstract

“…Based on model calculations, a higher effective dose [35,36] of two cycles of BEACOPP escalated followed by two cycles of ABVD (B2+ 2^) was compared to four cycles of ABVD in the GHSG HD14 trial; all patients received 30 Gy IFRT: the more intensive B2+2^approach resulted in a significantly improved FFTF at 5 years of 95.4 % as compared to 89.1 % in the ABVD arm with no difference in OS [37]. A subsequent analysis with 7 years of follow-up confirmed a PFS benefit (93.7 vs. 85.6 %) but indicated no difference in OS.…”

Section: Early-stage Unfavorable Hlmentioning

confidence: 99%

The GHSG Approach to Treating Hodgkin’s Lymphoma

Bröckelmann

Engert

2015

Curr Hematol Malig Rep

View full text Add to dashboard Cite

Hodgkin's lymphoma (HL) is a relatively rare disease accounting for 15 % of all lymphoma. This disease has developed from an incurable disease to the adult malignancy with the most favorable prognosis. With current therapeutic approaches consisting of polychemo- and small-field radiotherapy, up to 80 % of all patients can be cured long term. In refractory or relapsed HL, intensified treatment including high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) is associated with progression-free survival (PFS) of 50 %. Evaluation of novel drugs in multiple relapsed or refractory cases, better treatment options for elderly patients and reducing treatment-related side effects are the main focus of current research. Recent clinical developments and future approaches in the treatment of HL will be discussed in this review.

show abstract

“…One of such experiences was the Cancer and Leukemia Group B 9051 phase II study (Wasserman, Petroni, Millard, et al, 1999) which tested three cycles of etoposide, vinblastine, and doxorubicin (EVA) followed by subtotal lymphoid irradiation in 59 patients with CS I-III disease and unfavorable features (bleomycin was eliminated). CR rate was about 66% with high relapse rate of 20%.…”

Section: Brief Historical Background For Chemotherapy Use In Early Stmentioning

confidence: 99%