Early chemotherapy intensification with escalated beacopp in patients with advanced-stage hodgkin lymphoma with a positive interim positron emission tomography/computed tomography scan after two abvd cycles: Long-term results of the GITIL/FIL HD 0607 trial

A. Gallamini, C. Tarella, S. Viviani, A. Rossi, C. Patti, A. Mule, M. Picardi, A. Romano, M. Cantonetti, G.L. Nasa, L. Trentin, S. Bolis, D. Rapezzi, R. Battistini, D. Gottardi, P. Gavarotti, P. Corradini, M. Cimminiello, C. Schiavotto, G. ParvisR. Zanotti, G. Gini, A.J.M. Ferreri, P. Viero, M. Miglino, A. Billio, A. Avigdor, A. Biggi, F. Fallanca, U. Ficola, M. Gregianin, A. Chiaravalloti, G. Prosperini, F. Bergesio, S. Chauvie, C. Pavoni, A.M. Gianni, A. Rambaldi

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose To investigate the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL) after a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after two doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2). Patients and Methods Patients with advanced-stage (IIB to IVB) HL were consecutively enrolled. After two ABVD cycles, PET2 was performed and centrally reviewed according to the Deauville five-point scale. Patients with a positive PET2 were randomly assigned to four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by four cycles of standard BEACOPP with or without rituximab. Patients with a negative PET2 continued ABVD, and those with a large nodal mass at diagnosis (≤ 5 cm) in complete remission with a negative PET at the end of chemotherapy were randomly assigned to radiotherapy or no further treatment. The primary end point was 3-year PFS. Results Of 782 enrolled patients, 150 (19%) had a positive and 630 (81%) a negative PET2. The 3-year PFS of all patients was 82%. The 3-year PFS of those with a positive and negative PET2 was 60% and 87%, respectively (P > .001). The 3-year PFS of patients with a positive PET2 assigned to BEACOPP with or without rituximab was 63% versus 57% (P = .53). In 296 patients with both interim and post-ABVD-negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97% v 93%, respectively; P = .29). The 3-year overall survival of all 782 patients was 97% (99% and 89% for PET2 negative and positive, respectively). Conclusion The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage HL. © 2018 by American Society of Clinical Oncology.
Original languageEnglish
Pages (from-to)454-462
Number of pages9
JournalJournal of Clinical Oncology
Volume36
Issue number5
DOIs
Publication statusPublished - 2018

Keywords

  • alanine aminotransferase
  • antineoplastic agent
  • aspartate aminotransferase
  • bleomycin
  • cyclophosphamide
  • dacarbazine
  • doxorubicin
  • etoposide
  • fluorodeoxyglucose f 18
  • prednisone
  • procarbazine
  • rituximab
  • vinblastine
  • vincristine
  • add on therapy
  • adolescent
  • adult
  • advanced cancer
  • alanine aminotransferase blood level
  • Article
  • aspartate aminotransferase blood level
  • blood clotting disorder
  • blood toxicity
  • bone marrow toxicity
  • cancer combination chemotherapy
  • cancer growth
  • cancer mortality
  • cancer patient
  • cancer radiotherapy
  • cancer regression
  • cancer survival
  • classical Hodgkin lymphoma
  • controlled study
  • drug dose escalation
  • drug dose intensification
  • drug hypersensitivity
  • drug substitution
  • drug treatment failure
  • drug withdrawal
  • early intervention
  • event free survival
  • female
  • gastrointestinal infection
  • heart failure
  • hepatobiliary disease
  • human
  • long term survival
  • lung fibrosis
  • lung infection
  • lung toxicity
  • male
  • metabolic disorder
  • multiple cycle treatment
  • musculoskeletal disease
  • nausea and vomiting
  • neurotoxicity
  • neutropenia
  • open study
  • overall survival
  • pain
  • pancreas disease
  • phase 2 clinical trial
  • positron emission tomography-computed tomography
  • priority journal
  • progression free survival
  • randomized controlled trial
  • side effect
  • skin toxicity
  • soft tissue disease
  • treatment response
  • vascular disease
  • young adult

Fingerprint Dive into the research topics of 'Early chemotherapy intensification with escalated beacopp in patients with advanced-stage hodgkin lymphoma with a positive interim positron emission tomography/computed tomography scan after two abvd cycles: Long-term results of the GITIL/FIL HD 0607 trial'. Together they form a unique fingerprint.

Cite this