Abstract
Response-adapted omission of radiotherapy and comparison of consolidation chemotherapy in children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma (EuroNet-PHL-C1): a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial.
Highlights
Of 1287 patients in the per-protocol group, 514 (40%) had an adequate response to treatment and were not treated with radiotherapy (215 [49%] of 435 in treatment group 2 and 299 [35%] of 852 in treatment group 3). 773 (60%) of 1287 patients with inadequate response were scheduled for radiotherapy
Added value of this study With the results of our large multinational randomised trial (EuroNet-PHL-C1) in patients younger than 18 years of age with classical Hodgkin lymphoma, we showed that radiotherapy can safely be avoided in intermediate and advanced stage patients who have an adequate response to an intensified induction with vincristine, etoposide, prednisone, and doxorubicin chemotherapy
Of these 1365 patients, 1287 (94%) patients (435 [34%] were in treatment group 2 and 852 [66%] of 1287 were in treatment group 3) were included in the titration trial perprotocol analysis. 514 (40%) of 1287 patients with adequate response received no radiotherapy (215 [49%] of 435 in treatment group 2 and 299 [35%] of 852 in treatment group 3). 773 (60%) of 1287 patients with inadequate response were scheduled for radiotherapy (220 [51%] of 435 in the treatment group 2 and 553 [65%] of 852 in treatment group 3; figure 1), and all but one patient had a positive PET at early-response assessment (ERA)
Summary
Classical Hodgkin lymphoma is one of the most curable paediatric and adult cancers, with survival rates exce eding 90%.1–6 survivors are at high risk of secondary cancers, infertility, and cardiovascular disease after chemoradiotherapy.7–9The current challenge is to tailor therapy to avoid overtreatment or undertreatment. Patient subgroups, which differ in disease stage and in their treatment assignment, should have the same high cure rate, with as minimal treatment as possible.Building on a series of treatment optimisation trials since 1978,2 the European Network for Paediatric Hodgkin Lymphoma (EuroNet-PHL) adopted a common compre hensive treatment strategy on the basis of a combinedmodality scheme for early-stage (treatment group 1), Research in contextEvidence before this study Survivors of childhood and adolescent classical Hodgkin lymphoma are at high risk for secondary cancers, infertility, and cardiovascular disease later in their life after successful chemoradiotherapy combination treatment. Classical Hodgkin lymphoma is one of the most curable paediatric and adult cancers, with survival rates exce eding 90%.1–6. Survivors are at high risk of secondary cancers, infertility, and cardiovascular disease after chemoradiotherapy.. Patient subgroups, which differ in disease stage and in their treatment assignment, should have the same high cure rate, with as minimal treatment as possible. Evidence before this study Survivors of childhood and adolescent classical Hodgkin lymphoma are at high risk for secondary cancers, infertility, and cardiovascular disease later in their life after successful chemoradiotherapy combination treatment. The challenge is to sustain high cure rates while reducing long-term side-effects by reducing radiation exposure and avoiding gonadotoxic chemotherapy. PET after two or three cycles of chemotherapy is used for response-adapted therapy in patients with classical Hodgkin lymphoma. Convincing data in the literature on the long-term effect of procarbazine in girls and women are scarce
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