Hodgkin lymphoma Improved healing through shorter therapy?

Physicians are studying the effect of shortened therapy in Hodgkin's lymphoma

The so-called advanced Hodgkin lymphoma is treated with the help of chemotherapy. While effective, this treatment often has very serious acute and long-term side effects. Eight cycles of chemotherapy lead to a survival rate of about 90 percent after five years. Researchers have now been able to reduce the therapy to only four cycles, if affected respond positively to the treatment after only two cycles.

The scientists of the University of Cologne found in their investigation that in advanced Hodgkin's lymphoma, the chemotherapy used can be significantly shortened if affected respond well to the first two cycles of treatment. The physicians published the results of their study in the English-language journal "The Lancet".

Hodgkin's disease is a malignant tumor of the lymphatic system (malignant lymphoma). Experts noted that in some patients a significantly reduced treatment duration is sufficient for healing. (Image: magele-picture / fotolia.com)

Therapy should be shorter without losing effectiveness

Hodgkin's lymphoma is treated with the help of very intensive chemotherapy. Such treatment requires eight cycles to result in a 90 percent survival rate. Physicians were looking for ways to possibly reduce the duration of previous therapy. The aim of the German Hodgkin Study Group (DHSG) is to reduce the intensity of the therapy and also to improve the tolerability. However, there must be no loss of efficacy of the treatment, explain the scientists.

Significant therapy reduction to only four cycles is possible

"The results of DHSG's recent HD18 study have now shown that a significant treatment reduction to only four cycles is possible if they (the patients) have achieved a good response to treatment after just two cycles," said Professor Dr. Peter Borchmann, Senior Physician in the Clinic I for Internal Medicine at the University Hospital.

Experts examine over 2,000 subjects

Overall, the current study involved over 300 centers in five European countries (Germany, Austria, Switzerland, the Netherlands and the Czech Republic). The physicians examined 2,001 patients between the ages of 18 and 60 for their study. The subjects had previously received a first diagnosis of advanced Hodgkin's lymphoma. At baseline, participants received two cycles of current standard therapy (escalated BEACOPP). This was followed by a so-called nuclear medical examination (positron emission tomography, PET). In addition, a classical computed tomography (CT) was performed by the medical profession. Computed tomography makes it possible to visualize the metabolism in tissues. Not only can the size be determined by PET and CT, but also the vitality of a tumor can be checked and assessed, explain the physicians.

Participants were split into two groups

When participants responded positively to early therapy (PET negative), they were randomly assigned to two treatment groups. These received either six more cycles or a greatly reduced number of just two cycles of therapy. The scientists found that patients with only four cycles of therapy are just as effective as a normally administered therapy, which runs for eight cycles. When the chemotherapy was over, all patients were examined for the remnants of tumors. When tumor remnants were discovered, further irradiation continued, say the authors.

Less cycles of treatment reduce the side effects

Less cycles also reduced the acute and long-term side effects of the treatment. In addition, survival of participants improved significantly, say the authors. After five years, the survival rate was 98 percent. In addition, the entire therapy could be reduced from 24 weeks to only 12 weeks. "Patients can therefore take advantage of rehabilitation therapy earlier and find their way back into their lives, which significantly contributes to the quality of life," explains Professor Borchmann in a press release.

Conventional chemotherapy works reliably and ensures the survival of patients

If the participating patients were still PET-positive after two cycles of chemotherapy, the physicians in their study looked at intensifying the treatment by taking a so-called targeted antibody (rituximab), in addition to the classic chemotherapy regimen. The results of the study showed that control of tumors with the help of conventional chemotherapy works so well that another drug would not bring any additional benefit. This is good news for those affected. Even if patients do not respond early to treatment, they already have a very good chance of surviving with the help of proven chemotherapy. The cure rate is 96 percent after five years.

Adaptation of the current therapy is possible

Based on the current results, it is now possible to aim for an adjustment of the overall therapy intensity if patients respond to chemotherapy at an early stage. This could become a new standard treatment, the researchers hope. Because such an adaptation of the current therapy could really be crucial for a better tolerated, individualized, shorter and nevertheless highly effective treatment against cancer. (As)