ABVD or BEACOPPbaseline along with involved-field radiotherapy in early-stage Hodgkin Lymphoma with risk factors: Results of the European Organisation for Research and Treatment of Cancer (EORTC)–Groupe d'Étude des Lymphomes de l'Adulte (GELA) H9-U intergroup randomised trial

Christophe Fermé, José Thomas, Pauline Brice, Olivier Casasnovas, Andrej Vranovsky, Serge Bologna, Pieternella J. Lugtenburg, Réda Bouabdallah, Patrice Carde, Catherine Sebban, Houchingue Eghbali, Gilles Salles, Gustaaf W. van Imhoff, Antoine Thyss, Evert M. Noordijk, Oumédaly Reman, Marnix L.M. Lybeert, Maud Janvier, Michele Spina, Bruno AudhuyJohn M.M. Raemaekers, Richard Delarue, Bruno Anglaret, Okke de Weerdt, Zora Marjanovic, Robbert J.H.A. Tersteeg, Daphne de Jong, Josette Brière, Michel Henry-Amar, for the European Organisation for Research and Treatment of Cancer Lymphoma Group, and, the Groupe d'Étude des Lymphomes de l'Adulte

Research output: Contribution to journalArticle

Abstract

Purpose For early-stage Hodgkin lymphoma (HL), optimal chemotherapy regimen and the number of cycles to be delivered remain to settle down. The H9-U trial compared three modalities of chemotherapy followed by involved-field radiotherapy (IFRT) in patients with stage I-II HL and risk factors (NCT00005584). Patients and methods Patients aged 15–70 years with untreated supradiaphragmatic HL with at least one risk factor (age ≥ 50, involvement of 4–5 nodal areas, mediastinum/thoracic ratio ≥ 0.35, erythrocyte sedimentation rate (ESR) ≥ 50 without B-symptoms or ESR ≥ 30 and B-symptoms) were eligible for the randomised, open label, multicentre, non-inferiority H9-U trial. The limit of non-inferiority was set at 10% for the difference between 5-year event-free survival (EFS) estimates. From October 1998 to September 2002, 808 patients were randomised to receive either the control arm 6-ABVD-IFRT (n = 276), or one of the two experimental arms: 4-ABVD-IFRT (n = 277) or 4-BEACOPPbaseline-IFRT (n = 255). Results Results in the 4-ABVD-IFRT (5-year EFS, 85.9%) and the 4-BEACOPPbaseline-IFRT (5-year EFS, 88.8%) were not inferior to 6-ABVD-IFRT (5-year EFS, 89.9%): difference of 4.0% (90%CI, -0.7%–8.8%) and of 1.1% (90%CI,-3.5%–5.6%) respectively. The 5-year overall survival estimates were 94%, 93%, and 93%, respectively. Patients treated with combined modality treatment chemotherapeutic regimen comprising doxorubicin (Adriamycin), bleomycin, vincristine (Oncovin), cyclophosphamide, procarbazine, etoposide and prednisone (BEACOPP)baseline more often developed serious adverse events requiring supportive measures and hospitalisation compared with patients receiving the chemotherapeutic regimen comprising doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD). Conclusions The trial demonstrates that 4-ABVD followed by IFRT yields high disease control in patients with early-stage HL and risk factors responding to chemotherapy. Although non-inferior in terms of efficacy, four cycles of BEACOPPbaseline were more toxic than four or six cycles of ABVD.

Original languageEnglish
Pages (from-to)45-55
Number of pages11
JournalEuropean Journal of Cancer
Volume81
DOIs
Publication statusPublished - Aug 1 2017

Keywords

  • Chemotherapy
  • Early stage
  • Hodgkin lymphoma
  • Radiotherapy
  • Treatment efficacy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Fermé, C., Thomas, J., Brice, P., Casasnovas, O., Vranovsky, A., Bologna, S., Lugtenburg, P. J., Bouabdallah, R., Carde, P., Sebban, C., Eghbali, H., Salles, G., van Imhoff, G. W., Thyss, A., Noordijk, E. M., Reman, O., Lybeert, M. L. M., Janvier, M., Spina, M., ... the Groupe d'Étude des Lymphomes de l'Adulte (2017). ABVD or BEACOPPbaseline along with involved-field radiotherapy in early-stage Hodgkin Lymphoma with risk factors: Results of the European Organisation for Research and Treatment of Cancer (EORTC)–Groupe d'Étude des Lymphomes de l'Adulte (GELA) H9-U intergroup randomised trial. European Journal of Cancer, 81, 45-55. https://doi.org/10.1016/j.ejca.2017.05.005