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In a letter to the editor1 of the Journal of Clinical Oncology, Eliza Hawkes of the Olivia Newton-John Cancer Wellness & Research Centre, et al. further discuss findings initially published by Press et al.2 reporting findings of the Southwest Oncology Group (SWOG) S0816 study.
In Hawkes et al.’s letter, they noted that:
This letter to the editor also noted that the accompanying editorial by Borchmann and Engert4 highlights that:
Hawkes et al. criticized this observation by explaining that cross comparisons of trials with different study populations and definitions of poor prognosis can be unsound:
This indicates that the HD18 study may have included patients:
The RATHL and SWOG studies support existing data for the prognostic utility of PET2. Moreover, dose intensification from ABVD to BEACOPP in PET-positive patients with poor prognoses produced impressive PFS compared with historic controls, providing the rationale for individualized treatment. However, Hawkes et al. warn that these results need to mature and further randomized studies complemented with clinical trials exploring stratification using molecular profiles are required to validate the superiority of response-adapted dose intensification therapy.
Hawkes et al. also note that the evidence supporting escalated BEACOPP overlooks the significant toxicity and additional resources required. Improvements in managing patients with HL is likely to come from using novel, targeted agents for first-line therapy, such as brentuximab vedotin. But, for now, in Hawkes et al.’s opinion, there is no convincing evidence to contest the appropriateness of ABVD for the majority of advanced HL patients.
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