Less Intense Therapy May Be As Effective as Standard Care in Early-stage Hodgkin’s Lymphoma

Reduced-intensity therapy may be just as effective but less toxic than a more intense regimen for patients with early-stage Hodgkin’s lymphoma, German researchers report.

 

Four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy of involved-field radiation therapy is widely regarded as the standard of care for patients with early-stage Hodgkin’s lymphoma with a favorable prognosis. To determine whether the toxic effects of treatment could be reduced while retaining full disease control, the German Hodgkin Study Group randomized 1370 patients with newly diagnosed stage I or II Hodgkin’s lymphoma to one of four treatment groups: four cycles of ABVD followed by either 30 Gy or 20 Gy of radiation or two cycles of ABVD followed by 30 Gy or 20 Gy of radiation.

 

As reported by Andreas Engert, MD, of the University of Cologne, Germany, and colleagues in the April 12 issue of the New England Journal of Medicine, freedom from treatment failure, the primary end point, did not differ significantly between patients receiving the more- and less-intense chemotherapy regimens. At 5 years, the rates of freedom from treatment failure were 93.0% in those who received four cycles of chemotherapy compared with 91.1% in those who received two cycles. Overall survival was also similar with the two chemotherapy regimens.

 

Furthermore, the researchers found no significant differences in freedom from treatment failure or overall survival in patients treated with either 20 Gy or 30 Gy of radiation.

 

Adverse events and acute toxicity, however, were more frequent with the more intense therapy. Patients who received four cycles of chemotherapy and 30 Gy of radiation had the highest rates.

 

The authors conclude that in early-stage Hodgkin’s lymphoma, “a shorter chemotherapy regimen with a lower radiation dose preserves a high level of disease control.” They note though that long-term effects need to be fully assessed and that “with an overall survival rate of 95.1% at 8 years, some patients may still be overtreated.”