The study also showed that the 5-year failure-free survival was 85% for patients on ABVD versus 79% for those on Stanford V (HR=0.68; 95% CI: 0.37-1.25; P=0.22). The 5-year overall survival for ABVD was 96% compared with 92% for Stanford V (HR=0.49; 95% CI: 0.16-1.47; P=0.19). The findings suggest that there is no significant difference between the two treatment arms.1

In regard to safety, the incidence of grade 3 to 4 neutropenia was similar between ABVD and Stanford V arms. Researchers observed a higher incidence of grade 3 lymphopenia (83% vs. 46%; P<0.001) and grade 3 to 4 sensory neuropathy (7% vs. 1%) in the Stanford V arm compared with the ABVD arm.1

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Current clinical practice guidelines by the National Comprehensive Cancer Network (NCCN) already recommend ABVD for four cycles or the Stanford V regimen for 12 weeks for the treatment of patients with stage 1 and stage 2 unfavorable (bulky mediastinal disease or larger than 10 cm adenopathy with or without B symptoms) Hodgkin lymphoma.

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Selected patients younger than 60 may also receive escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) for 2 cycles plus ABVD for two cycles with involved site radiation therapy (ISRT).3

The use of ABVD in this patient population is a category 1 recommendation, while the Stanford V is a category 2A recommendation.3

However, the authors of this study conclude that “both regimens are acceptable treatment options for these patients” with bulky mediastinal disease.1

References

  1. Advani RH, Hong F, Fisher RI, et al. Randomized phase III trial comparing ABVD plus radiotherapy with the Stanford V regimen in patients with stages 1 or II locally extensive, bulky mediastinal Hodgkin lymphoma: a subset analysis of the North American Intergroup E2496 trial. J Clin Oncol. April 20, 2015. [Epub ahead of print]. pii: pii: JCO.2014.57.8138.
  2. What are the key statistics about Hodgkin lymphoma? American Cancer Society. Available at: http://www.cancer.org/cancer/hodgkindisease/detailedguide/hodgkin-disease-key-statistics. Updated March 4, 2015. Accessed April 22, 2015.
  3. NCCN Clinical Practice Guidelines in Oncology. Hodgkin Lymphoma. V2.2015. Available at: http://www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf. Accessed April 22, 2015.

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Hematologic Cancers In The Clinic Lymphoma