Collaborative Study Points to New Treatment Strategy for Early Stage Hodgkin Lymphoma

A pilot study led by a researcher at the Sylvester Comprehensive Cancer Center of the University of Miami Miller School of Medicine points to a new treatment strategy for patients with early stage, unfavorable risk Hodgkin lymphoma.

Craig Moskowitz, M.D.

“This pilot protocol involving four cycles of chemotherapy resulted in favorable outcomes for participants and may obviate the need for radiation therapy,” said Craig Moskowitz, M.D., professor of medicine and physician-in-chief, Oncology Service Line at Sylvester. “While further trials are needed, this approach may be more efficacious than standard treatment.”

Dr. Moskowitz was the senior author of the study, “Brentuximab Vedotin Combined with Chemotherapy in Patients with Newly Diagnosed Early Stage, Unfavorable Risk Hodgkin Lymphoma,” published in May in the Journal of Clinical Oncology. The multicenter study was the largest to date on early stage, unfavorable-risk Hodgkin lymphoma using this chemotherapy program. It included researchers at Memorial Sloan Kettering Cancer Center and five other institutions, and was supported by the Lymphoma Research Foundation and Seattle Genetics.

Currently, early-stage Hodgkin lymphoma patients with high risk factors, such as bulk disease, are treated differently than early-stage patients with favorable risk factors. They typically receive four to six cycles of chemotherapy followed by involved-site radiotherapy (ISRT) focusing on the disease volume.

The new study found that the combination of brentuximab vedotin (BV) with AVD (doxorubicin, vinblastine, and dacarbazine) was highly active in patients with newly diagnosed, early-stage, unfavorable-risk Hodgkin lymphoma, including those with bulky mediastinal disease.

From 2013 to 2019, a total of 117 patients between age 18 and 60 were enrolled in this pilot study, and 116 completed four cycles of BV + AVD chemotherapy. One cohort also received three weeks of radiation therapy, another received two weeks, a third cohort received three weeks with a small radiation field and a fourth received no radiation therapy at all.

“All of the treatment arms were equivalent, with only seven failures among the participants,” said Dr. Moskowitz. “Treatment with four cycles of BV + AVD alone was associated with a two-year progression-free survival of 97 percent.

Larger, randomized studies of short-course BV + AVD without RT in patients who achieve a complete metabolic response after chemotherapy are needed to confirm the data, said Dr. Moskowitz. “Sylvester will be the lead U.S. center for a major international study scheduled to begin this summer looking at protocols for early-stage Hodgkin lymphoma patients with favorable and unfavorable risk factors,” he said. “That will be another step forward in determining the best treatment strategy for these patients.”

Tags: Dr. Craig Moskowitz, Hodgkin lymphoma, Sylvester Comprehensive Cancer Center