Lower-Dose Treatments for Early-Stage Hodgkin Lymphoma Do Not Compromise Results
In a phase III trial, people with early-stage, low-risk Hodgkin lymphoma who received lower doses of chemotherapy and/or radiotherapy had clinical outcomes that were no worse than those of people who received higher doses. The results of the study, which tested strategies to reduce the toxic effects of treatment while maintaining efficacy, appear in the New England Journal of Medicine.
Dr. Andreas Engert of the University Hospital of Köln, Germany, and colleagues studied 1,190 people newly diagnosed with stage I or stage II Hodgkin lymphoma and no clinical risk factors (including advanced age, previous treatment for Hodgkin lymphoma, or concurrent disease) who had been assigned to one of four groups. Two groups received four cycles of ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine) and either 30 gray (Gy) or 20 Gy of involvedfield radiotherapy (IFRT). The other two groups received only two cycles of ABVD chemotherapy, with one getting the higher and the other the lower amount of IFRT.
In a phase III trial, people with early-stage, low-risk Hodgkin lymphoma who received lower doses of chemotherapy and/or radiotherapy had clinical outcomes that were no worse than those of people who received higher doses.
After 7.5 years, 96.6 percent of all study participants had a complete remission, and 8-year survival was 94.5 percent. People who received two rounds of chemotherapy did not fare worse than those who received four rounds; similarly, those who received 20 Gy of IFRT did not fare worse than those who received 30 Gy.
However, half of all people getting the higher dose of chemotherapy reported serious adverse events – including infections, hair loss, anemia, and other blood disorders – compared with one-third of those who received the lower dose. Six of the seven treatment-related deaths were in people who received the higher dose of chemotherapy. Serious toxic effects from radiation were about three times more likely with the higher dose of radiation than with the lower dose of radiation.
Although this trial did not include a no-radiotherapy comparison group, some experts believe that, given the long life expectancy of people with Hodgkin lymphoma who have early-stage favorable disease, radiation therapy should be avoided when possible to minimize the risk of second cancers. “I would recommend that physicians evaluate patients after two cycles of ABVD chemotherapy with PET imaging and possibly avoid radiotherapy altogether, unless there is a compelling reason to use radiotherapy,” says Dr. Richard Little, senior investigator in the Clinical Investigation Branch in the National Cancer Institute’s Division of Cancer Treatment and Diagnosis.
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This article was published in Coping® with Cancer magazine, September/October 2010.