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. "

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