{"entity":{"id":"paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019","kind":"paper","name":"PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study","aka":["AHL2011","Casasnovas 2019"],"tldr":"Starting with the most intensive Hodgkin chemotherapy and switching to the gentler standard once the scan cleared gave the same disease control with far less anaemia, bleeding risk and infection.","summary":"A randomised non-inferiority phase 3 study at 90 centres in Belgium and France. Eligible patients were aged 16 to 60 with newly diagnosed Hodgkin lymphoma excluding the nodular lymphocyte predominant subtype, performance status under 3, and stage III, IV or IIB with a mediastinum-to-thorax ratio of 0.33 or more or extranodal localisation. All patients received two cycles of escalated BEACOPP. The standard group then completed six cycles regardless of the scan; the scan-driven group switched to four cycles of ABVD if the scan after two cycles was negative and continued escalated BEACOPP if it was positive. The non-inferiority margin was 10 percentage points.\n\nFrom 19 May 2011 to 29 April 2014, 823 patients were enrolled, 413 to standard care and 410 to the scan-driven arm; 346 (84 per cent) of the scan-driven arm switched to ABVD and 51 (12 per cent) continued escalated BEACOPP. At a median follow-up of 50.4 months (interquartile range 42.9 to 59.3), five-year progression-free survival by intention to treat was 86.2 per cent (95 per cent confidence interval 81.6 to 89.8) with standard treatment and 85.7 per cent (81.4 to 89.1) with scan-driven treatment (hazard ratio 1.084, 0.737 to 1.596, p = 0.65).","asOf":"2026-10-01","links":[{"label":"Lancet Oncology 2019","url":"https://doi.org/10.1016/S1470-2045(18)30784-8"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30658935/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/30658935"}],"tags":["lymphoma-evidence"],"related":["lymphoma-roadmap"],"cancers":["advanced-stage-classical-hodgkin-lymphoma","hodgkin-lymphoma"],"sections":["chemotherapy","imaging"],"technologies":["pet-ct"],"targets":[],"drugs":["bleomycin","etoposide","doxorubicin","cyclophosphamide","vincristine","procarbazine","prednisone","vinblastine","dacarbazine"],"companies":["lysa"],"institutions":[],"pathways":[],"terms":["deauville-score","abvd-beacopp","non-inferiority"],"trials":["ahl2011","hd18","rathl"],"people":[],"bottlenecks":["b-toxicity-qol","b-survivorship"],"keyPapers":[],"journals":["lancet-oncology"],"dependsOn":[],"notes":[],"journal":"Lancet Oncology","year":2019,"doi":"10.1016/S1470-2045(18)30784-8","pmid":"30658935","authors":"Casasnovas RO, Bouabdallah R, Brice P, et al.","paperType":"rct","findings":["Five-year progression-free survival by intention to treat was 85.7 per cent with scan-driven treatment against 86.2 per cent with standard escalated BEACOPP (hazard ratio 1.084, 95 per cent confidence interval 0.737 to 1.596, p = 0.65), meeting non-inferiority.","346 of 410 patients (84 per cent) in the scan-driven arm switched to ABVD after a negative scan.","Grade 3 to 4 anaemia occurred in 69 per cent of the standard group against 28 per cent of the scan-driven group, and thrombocytopenia in 66 against 40 per cent.","Febrile neutropenia occurred in 35 against 23 per cent, and infections in 22 against 11 per cent.","Serious treatment-related adverse events were reported in 47 per cent of the standard group against 28 per cent of the scan-driven group; six treatment-related deaths occurred in the standard group."],"whatItMeans":"Confirmation, by a different route from HD18, that the interim scan can safely direct de-escalation in advanced Hodgkin lymphoma, and that most of the toxicity of escalated BEACOPP can be avoided in the 84 per cent of patients who respond early.","caveats":["Non-inferiority margin of 10 percentage points is wide for a disease with five-year progression-free survival above 85 per cent.","Open-label and investigator-assessed.","Everyone received two cycles of escalated BEACOPP first, so the trial does not test starting with ABVD."],"changedPractice":true,"participants":823},"route":"/key-papers/paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019/","neighbours":{"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting","route":"/roadmaps/lymphoma-roadmap/"}],"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"}],"technology":[{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"dacarbazine","kind":"drug","name":"Dacarbazine","route":"/drugs/dacarbazine/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"prednisone","kind":"drug","name":"Prednisone","route":"/drugs/prednisone/"},{"id":"procarbazine","kind":"drug","name":"Procarbazine","route":"/drugs/procarbazine/"},{"id":"vinblastine","kind":"drug","name":"Vinblastine","route":"/drugs/vinblastine/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"company":[{"id":"lysa","kind":"company","name":"LYSA (The Lymphoma Study Association)","route":"/companies/lysa/"}],"term":[{"id":"abvd-beacopp","kind":"term","name":"ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)","route":"/terms/abvd-beacopp/"},{"id":"deauville-score","kind":"term","name":"Deauville five-point scale","route":"/terms/deauville-score/"},{"id":"non-inferiority","kind":"term","name":"Non-inferiority trial","route":"/terms/non-inferiority/"}],"trial":[{"id":"ahl2011","kind":"trial","name":"AHL2011","route":"/trials/ahl2011/"},{"id":"hd18","kind":"trial","name":"GHSG HD18","route":"/trials/hd18/"},{"id":"rathl","kind":"trial","name":"RATHL","route":"/trials/rathl/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"journal":[{"id":"lancet-oncology","kind":"journal","name":"The Lancet Oncology","route":"/journals/lancet-oncology/"}],"paper":[{"id":"paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016","kind":"paper","name":"RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma","route":"/key-papers/paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016/"}]}}