Stanford V program for locally extensive and advanced Hodgkin lymphoma: the Memorial Sloan-Kettering Cancer Center experience

Edwards-Bennett, Sophia; Jacks, Lindsay M.; Moskowitz, Craig H.; Wu, Elise; Zhang, Z.; Noy, Ariela; Portlock, Carol S.; Straus, David J.; Zelenetz, Andrew D.; Yahalom, Joachim

doi:10.1093/annonc/mdp337

Cited by 33 publications

(17 citation statements)

References 25 publications

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“…In a subset analysis, when bulk was compared to other unfavorable factors as defined by the EORTC or GHSG, no differences were observed in the 10-year FFP [34]. Similar results have been reported by the Memorial Sloan- Kettering Cancer Center and United Kingdom groups [35,36]. …”

Section: Controversies Regarding Optimal Management Of ‘Unfavorable’ supporting

confidence: 64%

Current concepts and controversies in the management of early stage Hodgkin lymphoma

Maeda

Lee

Advani

2011

Leukemia & Lymphoma

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Over the past three decades, due to the recognition of late effects related to high-dose extended field radiotherapy and heavy alkylator chemotherapy, combined modality therapy with abbreviated chemotherapy and limited field radiotherapy has emerged as the standard of care for early stage Hodgkin lymphoma, with cure rates in excess of 80%. Currently, however, controversy remains over identifying the most appropriate criteria to risk-stratify patients with early stage disease, so that those with a favorable prognosis receive limited treatment without compromising cure rates and those with unfavorable risk receive more intensified therapy. The optimal risk stratification system remains unclear, with variable definitions of favorable and unfavorable disease used by research groups in North America and Europe. Thus, comparison of clinical trial results has been challenging, and additional controversies persist regarding optimal chemotherapy regimens, duration of therapy, and the role of radiotherapy. Investigations are ongoing to assess the potential of functional imaging and biomarkers as tools for risk stratification. The collective goal is to further refine current stratification strategies to allow for an individualized, risk-adapted treatment approach that minimizes long-term late effects without compromising high cure rates.

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Section: Controversies Regarding Optimal Management Of ‘Unfavorable’ supporting

confidence: 64%

Current concepts and controversies in the management of early stage Hodgkin lymphoma

Maeda

Lee

Advani

2011

Leukemia & Lymphoma

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“…NCCN Recommendations: ABVD, Stanford V (selected patients with IPS <3), or escalated-dose BEA-COPP (in selected patients aged <60 years with an IPS of ≥4) are included as options for primary treatment for patients with stage III-IV disease (see HODG-10; page 616). 61,64,66,67,84 In this setting, the ABVD regimen is preferred.…”

Section: Stage Iii-ivmentioning

confidence: 99%

“…ISRT (30-36 Gy; within 2-3 weeks after completion of chemotherapy) to initial sites >5 cm and involved spleen is recommended for patients with a Deauville score of 1 to 4 and for those with a Deauville score of 5 with a negative biopsy. 61,62 Patients with a positive biopsy should be managed as described for refractory disease.…”

Section: Stage Iii-ivmentioning

confidence: 99%

“…[60][61][62] In the Memorial Sloan Kettering Cancer Center study, 126 patients with either locally extensive or advanced disease were treated with the 12-week Stanford V chemotherapy regimen followed by 36 Gy of IFRT to bulky sites (≥5 cm) and/or to macroscopic splenic disease, 61 with 5-and 7-year OS rates of 90% and 88%, respectively. Of the patients for whom the Stanford V regimen failed, 58% underwent successful second-line therapy with high-dose therapy and autologous stem cell rescue (HDT/ASCR).…”

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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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“…Excellent phase II results were reported, with FFP and OS Ͼ 80%, along with preservation of fertility, low risk of pulmonary toxicity, and no leukemia or myelodysplasia. 12,13 In the Stanford experience, patients with a high IPS score (Ͼ 4) had an inferior outcome compared with those with IPS scores of 0-3. At a median follow-up of 10 years, the FFP and OS for IPS 0-3 versus 4-7 were 92% versus 68% and 98% versus 81%, respectively.…”

Section: What Is the Optimal Chemotherapy?mentioning

confidence: 99%

Optimal Therapy of Advanced Hodgkin Lymphoma

Advani

2011

Hematology

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Advanced-stage Hodgkin lymphoma (HL) has become a curable disease in the majority of patients. Research during the last decade has challenged chemotherapy with Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) as the standard of care and debates continue regarding the role of radiation therapy (RT) in this patient population. The incorporation of interim positron emission tomography (PET) imaging and, recently, further characterization of HL on cellular and molecular levels are emerging as tools for treatment stratification and predictors of disease status. Newer targeted therapies have emerged that are very effective in the relapsed setting and are actively being explored as frontline therapy. Lastly, the expanding population of survivors cured of HL outnumbers patients with the disease and needs to be monitored for therapy-related late effects.Therapeutic advances over the past 3 decades have resulted in the cure of the majority of patients with advanced-stage Hodgkin lymphoma (HL). Several questions emerge when considering what constitutes optimal therapy with a balance between a high cure rate and minimizing short-and long-term toxicity. This review focuses on 3 key elements: (1) what is the optimal chemotherapy?; (2) what is the role of radiation therapy (RT) in advanced HL?; and (3) can we adapt therapy based on clinical biological risk factors? What is the optimal chemotherapy?In North America, combination chemotherapy with Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) is considered the standard of care for advanced HL, providing an excellent balance of efficacy and toxicity. 1 Over the past decade, new regimens have been developed for patients with advanced HL based on the premise of either improved efficacy or reduced toxicity (Table 1). The major challenge to the clinician is how to interpret results from various clinical trials to individualize therapy and achieve a high cure rate while at the same time minimizing acute and late toxicity for patients with advanced HL. Dose-escalated bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone (escalated BEACOPP or escB), developed by the German Hodgkin Study Group (GHSG), has emerged as a very effective regimen and yielded significantly better survival compared with conventional-dose regimens in the GHSG HD9 study. 2 In a 3-armed trial, patients with stage IIB-IV HL were randomized to 8 cycles of COPP-ABVD, baseline BEACOPP (basB), or escB. Results from the most recent update of the study with 1196 evaluable patients and a median follow-up of 111 months suggest that responses are durable, with the 10-year freedom-from-treatment-failure (FFTF) significantly higher in the escB arm than in the basB and COPP-ABVD arms (82%, 70%, and 64%, respectively, P Ͻ .0001). The corresponding 10-year overall survival (OS) rates were 86%, 80%, and 75%, respectively (P ϭ .0005). 2 In contrast to the original publication, which indicated an OS benefit across all risk groups, on longer follow-up, the ...

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Stanford V program for locally extensive and advanced Hodgkin lymphoma: the Memorial Sloan-Kettering Cancer Center experience

Cited by 33 publications

References 25 publications

Current concepts and controversies in the management of early stage Hodgkin lymphoma

Current concepts and controversies in the management of early stage Hodgkin lymphoma

Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

Optimal Therapy of Advanced Hodgkin Lymphoma

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