Ongoing Efforts to Improve Survival and Minimize Toxicity

By S. Vincent Rajkumar, M.D.

Hodgkin's Disease represents one of the great success stories in hematology. The goal of ongoing trials is to improve and build upon the current successful treatment regimens and minimize toxicity and the occurrence of secondary malignancy. New advances in the treatment of Hodgkin's Disease are presented today in a Simultaneous Session and an Educational Session.

In today's Simultaneous Session Hodgkin Lymphoma: Treatment (4:15 p.m. - 5:45 p.m.), Dr. Ralph Meyer will present the results of a phase III clinical trial conducted by the Eastern Cooperative Oncology Group. The stan- dard therapy arm in this trial received either subtotal nodal radiation (low-risk disease) or 2 cycles ABVD plus subtotal nodal radiation (high-risk disease). Patients assigned to the experimental arm received ABVD alone for 4-6 cycles. Four hundred and five patients were studied and the median follow-up duration is just over 4 years. Progression free survival (PFS) was inferior in patients randomized to ABVD alone, with 5 year PFS estimates of 87% versus 93%, respectively. However, no differences in overall survival have been detected. The authors conclude that further follow-up is required to determine whether ABVD alone would be sufficient and lead to better overall survival given lower side effects in this arm.

The UK Lymphoma Group presents results of a randomized trial comparing ABVD versus two different multi-drug regimens: either ChlVPP/PABlOE or Hybrid ChlVPP/EVA. Eight hundred and seven patients were randomized in this trial. No significant difference in progression free survival or overall survival was seen between the two arms. At the same session, Dr. Anas Younes will present results of a trial using the novel combination of rituximab plus ABVD (R-ABVD) for newly diagnosed patients with classical Hodgkin's Disease. Given the relatively inferior results in patients with advanced Hodgkin's Disease, Dr. Volker Diehl and colleagues studied the role of the BEACOPP regimen in conjunction with radiation therapy at various doses.Results of this trial will also be presented at today's Simultaneous Session.

Clearly, Hodgkin's Disease is one of the most curable hematologic malignancies. Given the high existing suc- cess rates, a greater understanding of the biology of this disease is required to improve on current therapy. During yesterday's excellent Educational Session entitled Hodgkin's Lymphoma: Biology and Treatment Strategies for Primary, Refractory, and Relapsed Disease several of these advances and strategies were discussed in detail. The current therapy of patients at all stages of the disease and key prognostic factors were discussed. For those who missed it, there is an opportunity to attend the session today from 7:30 a.m. - 9:15 a.m.