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Only half of US patients with earlystage Hodgkin’s lymphoma (HL) receive combined modality treatment (CMT), according to results from the first analysis of population-based treatment patterns, which also show better survival with CMT than with chemotherapy alone. CMT with sequential chemotherapy and radiation has been the standard practice since the early 2000s because of its survival advantage. Late toxicities with radiation means that guidelines now suggest an option of therapy with chemotherapy alone, although this is controversial. The study investigated 20 600 patients with early-stage HL treated with CMT (n=10 200) or chemotherapy alone (n=10 400) between 2003 and 2011 using data from the National Cancer Data Base. Outcome data were available for 9296 patients diagnosed between 2003 and 2006.
The analysis showed that use of CMT declined from 59·4% in 2003 to 45·2% in 2011. CMT was associated with improved overall survival (hazard ratio 0·61, 95% CI 0·53–0·70) compared with chemotherapy alone over a median follow-up of 6·1 years. “American oncologists largely turned away from CMT, motivated by the fear of radiation-induced cancers, but this fear may be exaggerated considering advances in radiation oncology. In the meantime, we may have swayed half of patients away from the most efficacious treatment strategy”, says lead author Adam Olszewski (Brown University, Providence, RI, USA). He adds “CMT should be presented to patients as a standard of care, and discussion of chemotherapy alone should include a disclosure of the potential survival trade-off.” “This large dataset shows there is a survival advantage with CMT”,
agrees Tim Illidge (Manchester University, Manchester, UK). Illidge explained that several groups are investigating the use of responseadjusted PET to guide decisions on the use of radiotherapy. “For now, the best approach is to give CMT until we are better able to individualise treatment.” Further results showed treatment selection in the USA was associated with both clinical and socioeconomic factors, the odds of receiving CMT decreased with age and were lower for women in the youngest age group. Even after adjusting for insurance, income, and education, black patients were significantly less likely to receive CMT. Patients with private insurance were significantly more likely to be given CMT than those without.
Centre Jean Perrin, Ism/Science Photo Library
Combined treatment for only half of Hodgkin’s patients
Published Online January 16, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70018-5 For the study by Olszewski and colleagues see J Clin Oncol 2015; published online January 12. http://jco.ascopubs.org/content/ early/2015/01/09/ JCO.2014.58.7543
Susan Mayor
Adjuvant treatment for HER2-positive breast cancer Adjuvant paclitaxel and trastuzumab is effective in restricting disease recurrence for patients with lowrisk HER2-positive breast cancer, according to new research. The single group study administered the therapy prospectively to 406 patients with small, node-negative, HER2-positive tumours. Treatment consisted of 12 weeks of paclitaxel plus trastuzumab followed by 40 weeks of trastuzumab monotherapy. Median follow-up was 4 years, and 3-year disease-free survival was 98·7% (95% CI 97·6–99·8). “Historical data for outcomes for untreated stage I HER2-positive tumours demonstrates a risk of recurrence in the 10–30% range, suggesting that consideration of adjuvant therapy is warranted for the majority of these patients”, explained co-author Sara Tolaney (Dana Farber Cancer Institute, Boston, MA, USA). She pointed out that a trastuzumabwww.thelancet.com/oncology Vol 16 February 2015
paclitaxel regimen is less toxic than the standard regimens used for patients with high-risk tumours. Trials of trastuzumab have focused on women with stage II or III HER2-positive breast cancer. A randomised trial including patients with low-risk disease would be challenging. A trastuzumabnull group would struggle to accrue participants, in view of the perceived risks of recurrence; comparison of different chemotherapy regimens would need several thousand patients, many of whom would face needless toxicity. Data suggest that outcomes are significantly better if chemotherapy is added to trastuzumab, at least in metastatic disease, so a trastuzumabalone group would also be problematic. Prudence Francis (Peter MacCallum Cancer Centre, Melbourne, VIC, Australia) believes that Tolaney’s study is a sensible response to the impracticality of a randomised phase 3 trial for
patients at low risk of recurrence. “The results suggest that this regimen is a reasonable consideration for patients with appropriate node-negative HER2amplified early breast cancers”, Francis said. Women with very low-risk disease can forego intravenous treatment altogether. Almost 20% of the trial participants had tumours of 5 mm or less in size. Their prognosis is highly favourable, and they are unlikely to have relapsed even without treatment. At increased risk are patients with hormone-receptor-positive tumours (two-thirds of the study population). “We will continue to follow these patients for...10 years”, said Tolaney, who is also doing a phase 2 trial (ATEMPT trial) for stage I HER2-positive breast cancer, assessing trastuzumab emtansine versus paclitaxel and trastuzumab as a control for toxicity.
Published Online January 16, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70019-7 For the study by Tolaney and colleagues see N Engl J Med 2015; 372: 134–41
Talha Khan Burki e59
Only half of US patients with earlystage Hodgkin’s lymphoma (HL) receive combined modality treatment (CMT), according to results from the first analysis of population-based treatment patterns, which also show better survival with CMT than with chemotherapy alone. CMT with sequential chemotherapy and radiation has been the standard practice since the early 2000s because of its survival advantage. Late toxicities with radiation means that guidelines now suggest an option of therapy with chemotherapy alone, although this is controversial. The study investigated 20 600 patients with early-stage HL treated with CMT (n=10 200) or chemotherapy alone (n=10 400) between 2003 and 2011 using data from the National Cancer Data Base. Outcome data were available for 9296 patients diagnosed between 2003 and 2006.
The analysis showed that use of CMT declined from 59·4% in 2003 to 45·2% in 2011. CMT was associated with improved overall survival (hazard ratio 0·61, 95% CI 0·53–0·70) compared with chemotherapy alone over a median follow-up of 6·1 years. “American oncologists largely turned away from CMT, motivated by the fear of radiation-induced cancers, but this fear may be exaggerated considering advances in radiation oncology. In the meantime, we may have swayed half of patients away from the most efficacious treatment strategy”, says lead author Adam Olszewski (Brown University, Providence, RI, USA). He adds “CMT should be presented to patients as a standard of care, and discussion of chemotherapy alone should include a disclosure of the potential survival trade-off.” “This large dataset shows there is a survival advantage with CMT”,
agrees Tim Illidge (Manchester University, Manchester, UK). Illidge explained that several groups are investigating the use of responseadjusted PET to guide decisions on the use of radiotherapy. “For now, the best approach is to give CMT until we are better able to individualise treatment.” Further results showed treatment selection in the USA was associated with both clinical and socioeconomic factors, the odds of receiving CMT decreased with age and were lower for women in the youngest age group. Even after adjusting for insurance, income, and education, black patients were significantly less likely to receive CMT. Patients with private insurance were significantly more likely to be given CMT than those without.
Centre Jean Perrin, Ism/Science Photo Library
Combined treatment for only half of Hodgkin’s patients
Published Online January 16, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70018-5 For the study by Olszewski and colleagues see J Clin Oncol 2015; published online January 12. http://jco.ascopubs.org/content/ early/2015/01/09/ JCO.2014.58.7543
Susan Mayor
Adjuvant treatment for HER2-positive breast cancer Adjuvant paclitaxel and trastuzumab is effective in restricting disease recurrence for patients with lowrisk HER2-positive breast cancer, according to new research. The single group study administered the therapy prospectively to 406 patients with small, node-negative, HER2-positive tumours. Treatment consisted of 12 weeks of paclitaxel plus trastuzumab followed by 40 weeks of trastuzumab monotherapy. Median follow-up was 4 years, and 3-year disease-free survival was 98·7% (95% CI 97·6–99·8). “Historical data for outcomes for untreated stage I HER2-positive tumours demonstrates a risk of recurrence in the 10–30% range, suggesting that consideration of adjuvant therapy is warranted for the majority of these patients”, explained co-author Sara Tolaney (Dana Farber Cancer Institute, Boston, MA, USA). She pointed out that a trastuzumabwww.thelancet.com/oncology Vol 16 February 2015
paclitaxel regimen is less toxic than the standard regimens used for patients with high-risk tumours. Trials of trastuzumab have focused on women with stage II or III HER2-positive breast cancer. A randomised trial including patients with low-risk disease would be challenging. A trastuzumabnull group would struggle to accrue participants, in view of the perceived risks of recurrence; comparison of different chemotherapy regimens would need several thousand patients, many of whom would face needless toxicity. Data suggest that outcomes are significantly better if chemotherapy is added to trastuzumab, at least in metastatic disease, so a trastuzumabalone group would also be problematic. Prudence Francis (Peter MacCallum Cancer Centre, Melbourne, VIC, Australia) believes that Tolaney’s study is a sensible response to the impracticality of a randomised phase 3 trial for
patients at low risk of recurrence. “The results suggest that this regimen is a reasonable consideration for patients with appropriate node-negative HER2amplified early breast cancers”, Francis said. Women with very low-risk disease can forego intravenous treatment altogether. Almost 20% of the trial participants had tumours of 5 mm or less in size. Their prognosis is highly favourable, and they are unlikely to have relapsed even without treatment. At increased risk are patients with hormone-receptor-positive tumours (two-thirds of the study population). “We will continue to follow these patients for...10 years”, said Tolaney, who is also doing a phase 2 trial (ATEMPT trial) for stage I HER2-positive breast cancer, assessing trastuzumab emtansine versus paclitaxel and trastuzumab as a control for toxicity.
Published Online January 16, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70019-7 For the study by Tolaney and colleagues see N Engl J Med 2015; 372: 134–41
Talha Khan Burki e59
