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| |  ASH: Hodgkin's Patients Benefit from Less Intense Therapy By Charlene Laino SAN DIEGO, CA -- December 8, 2004 -- Patients with early-stage Hodgkin's disease may benefit from less intense therapy, a randomized trial shows. In a study of 1,000 patients, the cumulative dose of the standard chemotherapy cocktail of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by radiation therapy was safely reduced without compromising efficacy, reported Volker Diehl, MD, investigator, German Hodgkin's Lymphoma Study Group, University of Cologne, Cologne, Germany. With complete remission rates greater than 90%, a combined modality treatment of ABVD chemotherapy followed by involved field irradiation is considered the gold standard for the treatment of early-stage Hodgkin's lymphoma, he said. "But with secondary cancer and cardiopulmonary toxicities a concern, the question is, how much chemotherapy and radiation do we really need?" Reporting here on December 6th at the American Society of Hematology 46th Annual Meeting, Dr. Diehl said his team studied 1,000 patients with the goal of cutting chemotherapy and radiation doses as much as possible. Four courses of the chemotherapy regimen were compared with 2 courses, and 30 grays of radiation were compared with 20 grays. "What we found," he said, "is that 2 courses of chemotherapy are as good as 4 courses and that 20 grays of radiation are as good as 30 grays." In the study, patients were randomized to 1 of 4 arms -- 4 cycles of ABVD plus 30 grays of radiation, 4 cycles of ABVD plus 20 grays, 2 cycles of ABVD plus 30 grays, or 2 cycles of ABVD plus 20 grays. There were 250 patients in each arm, Dr. Diehl said. After an average 3 years of follow-up, overall and tumor-free survival rates in all 4 arms was about 97%, Dr. Diehl reported. Progressive or stable disease was observed in 0.9% of patients. The most common grade 3 or 4 toxicity was leukopenia, detected in about one fifth of patients. "Since the adverse events were minimal, the results suggest that the intensity of therapy might be further reduced," said Dr. Diehl. The next step, he said, is a study using 2 drugs instead of 4. Seven hundred patients are already enrolled in such a study.
[Presentation title: "Reduction of Combined Modality Treatment Intensity in Early Stage Hodgkin's Lymphoma: Interim Analysis of the HD 10 Trial of the GHSG." Poster 1307]
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