At the International Malignant Lymphoma Conference (ICML 2023), Dr. Massimo Federico from University of Modena and Reggio Emilia, presented a captivating report on 10-Year Follow-up Analysis of the EORTC/LYSA/FIL H10 Randomized Intergroup Trial during the “Focus on Hodgkin Lymphoma” session. Oncology Frontier specially invited Dr. Federico for an in-depth interview on this topic.
Oncology Frontier: Could you please introduce the current treatment status of patients with stage I/II Hodgkin lymphoma? What treatment methods are available in clinical practice?
Dr. Federico: According to the current guidelines, the standard treatment for stage I/II Hodgkin lymphoma patients is a combined regimen, specifically chemotherapy combined with involved-field radiotherapy. In the past 20 years, research has explored the possibility of avoiding radiotherapy or escalating chemotherapy regimens following unsatisfactory responses to initial treatments. Based on this, we designed the H10 study: a randomized phase III clinical trial comparing a PET-adapted regimen with the standard chemo-radiotherapy approach. The trial incorporated involved-node radiotherapy, which irradiates only the initially positive areas, limiting the treated region. For patients who remained PET-positive after early evaluations, an escalated BEACOPP was administered for two courses. For those who responded well and became PET-negative, the treatment continued with just chemotherapy. PET-positive patients had their treatment strategies modified, adding escalated BEACOPP for two more courses on top of the initial ABVD.
Oncology Frontier: Your team reported a 10-year long-term follow-up analysis of the H10 trial. Could you discuss this study and its findings in detail?
Dr. Federico: The primary outcome of this study is that a PET-positive status serves as a robust predictor of outcome. Over time, PET-positive patients have an elevated risk of treatment failure compared to those who are PET-negative. In the case of PET-positive, the addition of BEACOPP to the standard regimen leads to an improved progression-free survival (PFS). However, the significance of this improvement diminishes in the 10-year data compared to the findings five years earlier. Among the PET-negative patients who received either chemotherapy alone or combined with involved-node radiotherapy, the combined approach yielded longer PFS. Across all subgroups in our study, overall survival was high for both standard and experimental arms. In summary, combining chemo-radiotherapy with involved-node radiotherapy is a safe method, with no associated increased risk of secondary malignancies. Likewise, for patients still PET-positive after two ABVD courses, escalating to BEACOPP is advisable, as this regimen doesn’t elevate the risk of secondary malignancies.
Oncology Frontier: How will these research findings impact clinical practice? Can you share the significance of this study based on your clinical experience?
Dr. Federico: The study underscores that both strategies, using PET to avoid radiotherapy and intensifying treatment for PET-positive patients, can achieve excellent outcomes. Currently, we have two treatment options. Using involved-node radiotherapy results in a lower risk of relapse, while BEACOPP, when applied in the case of PET-positive extends progression-free survival. Notably, there’s no difference in the survival rates across both strategies. Thus, we can inform patients, allowing them to decide between a lesser treatment with potentially higher curable relapse risk or a slightly more intensive treatment that reduces relapse risk.
