{"entity":{"id":"paper-eortc-h10-pet-adapted-early-hodgkin-jco-2017","kind":"paper","name":"Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial","aka":["H10","André 2017","EORTC H10"],"tldr":"In early Hodgkin lymphoma, switching to more intensive chemotherapy when the scan was still positive raised five-year freedom from progression from 77 to 91 per cent.","summary":"A randomised trial evaluating treatment adapted to the scan after two cycles of ABVD in previously untreated stage I and II Hodgkin lymphoma, classified by European Organisation for Research and Treatment of Cancer criteria as favourable or unfavourable. The standard arm was ABVD with involved-node radiotherapy regardless of the scan. In the experimental arm, scan-negative patients received ABVD alone, tested for non-inferiority, and scan-positive patients switched to two cycles of escalated BEACOPP with involved-node radiotherapy, tested for superiority.\n\nOf 1,950 randomly assigned patients, 1,925 had an early scan, and 361 (18.8 per cent) were positive. In scan-positive patients, five-year progression-free survival improved from 77.4 per cent with ABVD and radiotherapy to 90.6 per cent with escalated BEACOPP and radiotherapy (hazard ratio 0.42, 95 per cent confidence interval 0.23 to 0.74, p = 0.002). In scan-negative patients, five-year progression-free survival in the favourable group was 99.0 against 87.1 per cent in favour of combined treatment (hazard ratio 15.8, 3.8 to 66.1) and in the unfavourable group 92.1 against 89.6 per cent (hazard ratio 1.45, 0.8 to 2.5); non-inferiority of ABVD alone could not be demonstrated in either group.","asOf":"2026-10-01","links":[{"label":"Journal of Clinical Oncology 2017","url":"https://doi.org/10.1200/JCO.2016.68.6394"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/28291393/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/28291393"}],"tags":["lymphoma-evidence"],"related":["lymphoma-roadmap"],"cancers":["early-stage-classical-hodgkin-lymphoma","hodgkin-lymphoma"],"sections":["radiation","chemotherapy","imaging"],"technologies":["pet-ct","radiotherapy","imrt-igrt"],"targets":[],"drugs":["doxorubicin","bleomycin","vinblastine","dacarbazine","etoposide","cyclophosphamide","vincristine","procarbazine","prednisone"],"companies":[],"institutions":[],"pathways":[],"terms":["deauville-score","abvd-beacopp","non-inferiority"],"trials":["eortc-h10","hd16","radar-hodgkin"],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2017,"doi":"10.1200/JCO.2016.68.6394","pmid":"28291393","authors":"André MPE, Girinsky T, Federico M, et al.","paperType":"rct","findings":["In scan-positive patients, five-year progression-free survival rose from 77.4 per cent with ABVD and involved-node radiotherapy to 90.6 per cent with escalated BEACOPP and involved-node radiotherapy (hazard ratio 0.42, 95 per cent confidence interval 0.23 to 0.74, p = 0.002).","361 of 1,925 patients with an early scan (18.8 per cent) were positive.","In scan-negative favourable-group patients, five-year progression-free survival was 99.0 per cent with combined-modality treatment against 87.1 per cent with ABVD alone (hazard ratio 15.8, 3.8 to 66.1).","In scan-negative unfavourable-group patients the figures were 92.1 against 89.6 per cent (hazard ratio 1.45, 0.8 to 2.5).","Non-inferiority of ABVD alone could not be demonstrated in either risk group."],"whatItMeans":"The interim scan should be used to intensify treatment in early Hodgkin lymphoma, not to withhold radiotherapy. The 99.0 per cent five-year progression-free survival in the scan-negative favourable group with combined-modality treatment is the number any radiotherapy-sparing strategy has to match.","caveats":["The scan-positive comparison involves 361 patients, so the confidence interval around the hazard ratio of 0.42 is wide.","Escalated BEACOPP carries infertility and second-malignancy risks that a five-year progression-free survival endpoint does not capture.","The hazard ratio of 15.8 in the favourable scan-negative group rests on a small number of events and should be read as a direction rather than a magnitude."],"changedPractice":true,"participants":1925},"route":"/key-papers/paper-eortc-h10-pet-adapted-early-hodgkin-jco-2017/","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":"early-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Early-stage classical Hodgkin lymphoma (stage I to II)","route":"/cancers/early-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/"},{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"technology":[{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"}],"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/"},{"id":"radiotherapy","kind":"term","name":"Radiotherapy","route":"/terms/radiotherapy/"}],"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/"}],"trial":[{"id":"eortc-h10","kind":"trial","name":"EORTC/LYSA/FIL H10","route":"/trials/eortc-h10/"},{"id":"hd16","kind":"trial","name":"GHSG HD16","route":"/trials/hd16/"},{"id":"radar-hodgkin","kind":"trial","name":"RADAR","route":"/trials/radar-hodgkin/"}],"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":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}],"idea":[{"id":"lymphoma-ev-radiotherapy-free-early-hodgkin","kind":"idea","name":"A radiotherapy-free cure for early Hodgkin lymphoma that actually holds","route":"/ideas/lymphoma-ev-radiotherapy-free-early-hodgkin/"}]}}