Tuesday, August 31, 2010

HD10 published: 20Gy and 2 cycles ABVD

in the NEJM:

HD10 is published after a series of abstracts, all reaching the same conclusion: reduced intensity treatment is effective in early stage, favorable Hodgkin's lymphoma. This was a 2x2 non-inferiority trial looking at 30Gy vs 20Gy IFRT and 2 vs 4 cycles of ABVD; and no differences were noted in any clinical endpoint in the 1370 patients enrolled. The tempting comparison of 20Gy and 2 cycles vs 30Gy and 4 cycles is not a valid comparison in this trial due to the 2x2 design, but as a post-hoc analysis the authors did do this, demonstrating no difference in the most intense treatment and the least intense treatment (with HR 1.07 0.65-1.77, and an absolute difference of 1.6% at 5yr FFTF).

I think this now becomes the standard of care in these patients; however - one must be careful to differentiate between favorable and unfavorable early stage HD. Unfortunately, this quite important piece of information was delegated to an online only supplement. To sum up: those with any risk factor were excluded. This includes: large medistinal mass (>= 1/3 of the maximum thoracic diameter), extranodal disease, involvement with >2 nodal areas, and an elevated ESR (>=50mm for IA and IIA, and >=30mm for IB and IIB). Clinicians must be mindful of this when deintensifying treatment.

Link to the article.

Reduced Treatment Intensity in Patients with Early-Stage Hodgkin's Lymphoma: "New England Journal of Medicine, Volume 363, Issue 7, Page 640-652, August 2010. "

Monday, August 2, 2010

PSA screening for Prostate Cancer

In the Lancet Oncology this week:

The results of a PSA screening trial is published from Sweden. 20,000 men were randomized between PSA screening every two years vs. no screening. With 14 years follow up, the number of men diagnosed with prostate cancer was 12.7% in the screened vs 8.4% in the non-screened populace. This translated to a HR of 1.64 (1.5-1.8 95% CI) for prostate cancer diagnosis. More importantly the HR for death of prostate cancer was 0.44 with screening (0.28-0.68 95% CI), though no difference was seen in overall survival. The number needed to screen (NNS) was 293, and the number needed to treat (NNT) was 12 to prevent one prostate cancer death. Not surprisingly the majority of the benefit was seen over 10 years out.

This is a higher reduction in risk than that seen in two prior studies (the ERSPC and the PLCO studies), so there is some conflicting data on this subject to be aware of (the ERSPC tiral was positive, but to a lesser degree, and the PLCO study was negative). The authors present a rationale for why the results were more pronounced in this study in their discussion.

[Articles] Mortality results from the Göteborg randomised population-based prostate-cancer screening trial: "Prostate cancer is one of the leading causes of death from malignant disease among men in the developed world. One strategy to decrease the risk of death from this disease is screening with prostate-specific antigen (PSA); however, the extent of benefit and harm with such screening is under continuous debate."