Hodgkin lymphoma patients can be spared the serious side effects of chemotherapy thanks to high-tech scans that can predict the outcome of treatment, according to a study published in the New England Journal of Medicine. The study was led by Peter Johnson, professor of medical oncology at the University of Southampton.
Doctors – funded by Cancer Research UK and international partners in Europe and Australasia – used positron emission tomography (PET) to scan more than 1,200 patients with advanced Hodgkin lymphoma after they had been given two cycles of standard chemotherapy.
Those who had a clear PET scan were split into two groups – one group continued with chemotherapy including the drug bleomycin and the other had chemotherapy without the drug. They found that patients who stopped having bleomycin had the same survival rates as those who continued it. But, importantly, they were spared side effects.
Patients on the trial who did not have a clear PET scan after two rounds of chemotherapy, suggesting they had a more resistant form of the disease, were given more intense chemotherapy treatment.
Bleomycin has been an important drug to treat Hodgkin lymphoma for 30 years, but it has a potential risk of severe effects on the lungs, with the risk of scarring, even years later, that can lead to serious breathing problems.
Due to these risks the researchers wanted to explore the potential of adapting treatment by stopping bleomycin for patients with a good outlook and escalating treatment only for those at highest risk of the treatment not working.
“The good news is that the majority of people diagnosed with Hodgkin lymphoma can be cured – in this trial more than 95 per cent of patients are alive after three years,” Johnson said. “Knowing which patients have a more difficult to treat form of the disease means we can select those who need stronger chemotherapy, while sparing everyone else the severe side effects such as infertility. This approach, along with a reduction in the need for radiotherapy, should substantially reduce damage to healthy tissues and the risk of second cancers caused by treatments.”
The trial was run from the Cancer Research UK and UCL Cancer Trials Centre.