Злокачественные опухоли

Расширенный поиск


Полный текст:


The best treatment strategy for advanced stage Hodgkin lymphoma (HL) is still a matter of debate. There are three questions which discuss.

1. What is better: starting with the less toxic ABVD regimen which relapse free survival only of 60‑70 % at 5 years and try to salvage relapsing patients with high‑dose chemotherapy (CT) or starting with the more effective, but more toxicity BEACOPP escalated (FFTF at 5 years 87 %) in order to cure as many patients as possible at once. Several modification of BEACOPP escalated were tested to reduce toxicity. Meta‑analysis of 14 trials, including 10,011 patients shows that only 6 cycles of BEACOPP escalated and 8 cycles of BEACOPP‑14 were associated with the lowest risk for death of any cause and have the advantage of a five‑year survival rate for ABVD. In Russian protocol LHMoscow‑1‑3 for advanced stage HL the efficacy of another modified regime 6EACOPP‑14 was similar to 8BEACOPP‑14 by progression‑ free survival rate (PFS) 89 %, overall survival (OS) 96.3 % and toxicity.

2. Which dose radiotherapy (RT) and whom are need? After MOPP regimen, there might be a potential advantage of involved field RT (IFRT) as detected by a meta‑analysis of 16 randomized studies, whereas this advantage is not evident after ABVD. In the past decades, increasing knowledge on the long‑term effects of ionizing radiation, such as secondary malignancies, pulmonary toxicity, and cardiovascular damage, has led to increasing skepticism towards RT among patients and physicians. However, long term analysis (median of follow up more then 10 years) shows that 12‑years OS better without RT because less secondary malignancies and cardiovascular damage. But tumor control (PFS) is better with RT. With the development of modern radiation techniques, smaller field sizes, and lower doses, the side effects of radiotherapy and the expected long‑term effects can be reduced substantially.

3. Early PET response after two cycles CT is an important tool for planning risk‑adapted treatment in advanced HL. Many prospective trails are in going to answer this question. Therefore, current concepts include early response evaluation, guided by FDG‑PET, into treatment strategies and will hopefully define a new standard of care in which each patient receives as much therapy as needed.

Об авторе

Е. А. Демина
ФГБУ Российский онкологический научный центр им. Н. Н. Блохина РАМН

Список литературы

1. DeVita Jr VT, Simon RM, Hubbard SM, Young RC, Berard CW, Moxley JH, et al. Curability of advanced Hodgkin’s disease with chemotherapy. Long-term follow-up of MOPPtreated patients at the National Cancer Institute. Ann Intern Med. 1980;92:587-95.

2. Longo DL, Young RC, Wesley M, Hubbard SM, Duffey PL, Jaffe ES, et al. Twenty years of MOPP therapy for Hodgkin’s disease. J Clin Oncol. 1986;4:1295-306.

3. Bonadonna G, Valagussa P, Santoro A. Alternating noncross-resistant combination chemotherapy or MOPP in stage IV Hodgkin’s disease. A report of 8-year results. Ann Intern Med. 1986;104:739-46.

4. Santoro A, Bonadonna G, Valagussa P, Zucali R, Viviani S,Villani F, et al. Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin’s disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol. 1987;5:27-37.

5. Canellos GP, Niedzwiecki D: Long-term follow-up of Hodgkin’s disease trial. N Engl J Med. 2002;346:1417-8.

6. Schmitz N, Pfistner B, Sextro M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin disease: a randomized trial. Lancet. 2002;359 (9323):2065-71.

7. Josting A, Rudolph C, Mapara M, Glossmann JP, Sieniawski M, Sieber M, et al. Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG). Ann Oncol. 2005;16:116-23.

8. Engert A, Diehl V, Franklin J, Lohri A, Dorken B, Ludwig WD, et al. Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin’s lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol. 2009;27:4548-54.

9. Federico M, Luminari S, Iannitto E, Polimeno G, Marcheselli L, Montanini A, et al. ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin’s lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial. J Clin Oncol. 2009;27:805-11.

10. Viviani S, Zinzani PL, Rambaldi A., et al. ABVD versus BEACOPP for Hodgkin’s Lymphoma when High-Dose Salvage is planned. N Engl J Med 2011;365:203-12.

11. Borchmann P, Trelle S, Rancea M, et al. First Line Treatment of Advanced Stage Hodgkin Lymphoma with Six Cycles of BEACOPPescalated Results in Superior Overall Survival Compared to ABVD: Results of a Network Meta-Analysis Including 10,011 Patients. Blood 2012; 120, Issue 21, abstr 551

12. Hodgson DС, Gilbert ES, Dores GM, et al. Long-term solid cancer risk among 5-year survivors of Hodgkin‘s lymphoma. J Clin Oncol.2007;25:1489-97.

13. Myrehaug S, Pintilie M, Yun L, et al. A population-based study of cardiac morbidity among Hodgkin lymphoma patients with preexisting heart disease. Blood 2010; 116 (13): 2237-2240

14. Andrieu JM, Yilmaz U, Colonna P. MOPP versus ABVD and low-dose versus high-dose irradiation in Hodgkin’s disease at intermediate and advanced stages: analysis of a meta-analysis by clinicians. J Clin Oncol. 1999;17:730-4.

15. Loeffler M, Brosteanu O, Hasenclever D, Sextro M, Assouline D, Bartolucci AA, et al. Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin’s disease. International Database on Hodgkin’s Disease Overview Study Group. J Clin Oncol. 1998;16: 818-29.

16. Aleman BM, Raemaekers JM, Tirelli U, Bortolus R, van ‘t Veer MB, Lybeert ML, et al. Involved-field radiotherapy for advanced Hodgkin’s lymphoma. N Engl J Med. 2003; 348:2396-406.

17. Sonet A, et al. Long-term results and competing risk analysis of the H89 trial in patients with advanced-stage Hodgkin lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Blood. 2006;107:4636-42.

18. Diehl V, H. H, Mueller RP, Eich HT, Mueller-Hermelink H, Cerny T, Eight Cycles of BEACOPP Escalated Compared with 4 Cycles of BEACOPP Escalated Followed by 4 Cycles of BEACOPP Baseline with Or without Radiotherapy in Patients in Advanced Stage Hodgkin Lymphoma (HL): Final Analysis of the Randomised HD12 Trial of the German Hodgkin Study Group (GHSG). Blood (ASH Annual Meeting Abstracts). 2008; 112, Abstract 1558.

19. Engert A, Haverkamp H, Kobe C, Markova J, et al. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin’s lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet 2012;379 (9828):1791-9.

20. Meyer RM, Gospodarowicz M, Connor JM, et al. Final Analysis of a Randomized Comparison of ABVD Chemotherapy with a Strategy That Includes Radiation Therapy (RT) in Patients with Limited-Stage Hodgkin Lymphoma (HL): NCIC CTG / ECOG HD.6. N Engl J Med. 2011;366 (5):399-408.


Для цитирования:


For citation:


Просмотров: 560

Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.

ISSN 2224-5057 (Print)
ISSN 2587-6813 (Online)