Optimisation of adaptive therapy for advanced Hodgkin lymphoma
Mené en Belgique et en France sur 823 patients atteints d'un lymphome hodgkinien récemment diagnostiqué (âge : 16-60 ans), cet essai de phase III évalue l'intérêt, du point de vue de la survie sans progression, de remplacer en cours de traitement une chimiothérapie de type BEACOPP renforcée par une chimiothérapie de type ABVD (doxorubicine, bléomycine, vinblastine et dacarbazine), en fonction des résultats des examens de suivi par tomographie par émission de positons (durée médiane de suivi : 50,4 mois)
Management of advanced-stage Hodgkin lymphoma balances tumour control with therapy toxicity. Multiple studies have established the importance of increased-dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP escalated) in providing long-term tumour control for patients with this disease, but this treatment is associated with extended haematological toxicity in normal tissue, including myelodysplasia and secondary malignancies. Some physicians are cautious about giving BEACOPP escalated to patients partly because of concerns that toxicity subtracts from the potential advantage of upfront tumour control. Conventional treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) with the option of dose escalation in patients who respond minimally to upfront therapy is often preferred. Other physicians, however, argue that more aggressive upfront therapy with the option for de-escalation could lead to optimum outcomes for patients.
The Lancet Oncology , commentaire, 2018