Stephen M. Ansell, MD, PhD, Professor of Medicine in the Department of Hematology at the Mayo Clinic, Minnesota, underscored the importance of the HD17 trial results. “These data show, in a randomized fashion, that a PET-directed approach when using more intensive chemotherapy allows for the omission of radiation therapy in patients with limited-stage classical Hodgkin lymphoma, even when patients have unfavorable prognostic features,” Dr. Ansell told The ASCO Post.

Stephen M. Ansell, MD, PhD

“Because the prognosis of patients included in this study is generally excellent, the omission of radiotherapy that could potentially cause long-term toxicity is a significant advance,” continued Dr. Ansell. “However, when applying these results to standard practice, it is important to note that initial intensification of chemotherapy (two cycles of escalated BEACOPP followed by two cycles of ABVD) is necessary, as the same results have not been demonstrated with the use of standard-dose ABVD chemotherapy for four cycles.”

According to Dr. Ansell, this may limit this strategy to younger patients. He noted the clinical trial limited enrollment to patients younger than age 60.

Clinical Implications

“It will also be important to utilize experienced radiologists or nuclear medicine physicians in the interpretation of the PET scan, as the omission of radiation therapy requires a Deauville score of 1 or 2,” Dr. Ansell added. “Based on the study results, approximately one-third of patients might not be eligible for omission of radiation therapy, as they will have a Deauville score of 3 or 4. Although patients with a Deauville score of 4 have a significant risk of relapse, the correct strategy is not entirely clear for patients with a Deauville score of 3. All told, however, these data are important, as they allow us to identify patients with very good outcomes and decrease the intensity of treatment in these patients.”

DISCLOSURE: Dr. Ansell has received honoraria from Research to Practice and WebMD and has received institutional research funding from Affimed, AI Therapeutics, Bristol Myers Squibb, Pfizer, Regeneron, Seattle Genetics, and Trillium Therapeutics.