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An international trial asking whether swapping one old chemotherapy drug for a targeted antibody lets most people with early Hodgkin lymphoma avoid radiotherapy altogether.
RADAR is two parallel trials sharing one analysis: trial 1 led by University College London across Europe, Australia and New Zealand, trial 2 led by the Canadian Cancer Trials Group across North America, with the datasets combined to reach the target of 1,042 participants.
Participants are randomised to ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) or A2VD, which replaces the bleomycin with brentuximab vedotin and adds growth factor support. Everyone has a centrally reviewed scan after two cycles. A Deauville score of 1 to 3 means one further cycle of the randomised chemotherapy and then follow-up with no radiotherapy at all. A Deauville score of 4 means two further cycles followed by involved-site radiotherapy. A Deauville score of 5 means coming off trial treatment. Follow-up runs for a minimum of five years, and primary completion is estimated for September 2030.
The design is a direct response to HD16 and EORTC H10, which both showed that an interim scan alone is not enough to justify dropping radiotherapy. RADAR changes the chemotherapy as well, on the hypothesis that a more active regimen will make the omission safe. The primary endpoint is progression-free survival. Sites are open in Australia, Belgium, Canada, Denmark, Ireland, the Netherlands, New Zealand, Portugal, Slovakia, Spain, the United Kingdom and the United States.
Radiotherapy cannot be omitted in early-stage favourable Hodgkin lymphoma on the basis of a negative interim scan without a clinically relevant loss of tumour control. The scan is better at identifying who needs more than at identifying who needs less.
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.
The reason cardiac surveillance belongs in Hodgkin lymphoma survivorship care, the reason smoking cessation is a specific intervention for this group rather than general advice, and part of the reason modern protocols try to limit both mediastinal radiation and cumulative anthracycline dose.
The reason every current Hodgkin lymphoma trial is a de-escalation trial, and the reason survivors need lifelong surveillance rather than discharge at five years. It is also a warning about assuming that a gentler protocol is a safer one until a cohort has been followed long enough to say.
Shares Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk, Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, GHSG HD16, EORTC/LYSA/FIL H10 and the tag lymphoma-evidence.
Shares Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk, Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Brentuximab vedotin, Early-stage classical Hodgkin lymphoma (stage I to II) and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.
Shares Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk, Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Bleomycin, Survivorship and late effects are neglected and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Bleomycin, Survivorship and late effects are neglected and the tag lymphoma-evidence.
Shares Positron emission tomography-guided treatment in early-stage favorable Hodgkin lymphoma: final results of the international, randomized phase III HD16 trial by the German Hodgkin Study Group, Deauville five-point scale, Early-stage classical Hodgkin lymphoma (stage I to II), PET/CT and the tag lymphoma-evidence.