This article is more than 5 years old. Information may no longer be current.
Trend against combined-modality therapy for early-stage Hodgkin's lymphoma may impact survival
Click Here to Manage Email Alerts
Socioeconomic factors often influenced the decision to eliminate radiation therapy from the treatment of classic non-Hodgkin’s lymphoma, according to study results.
The trend away from combined-modality therapy — or chemotherapy and radiation therapy — may negatively impact survival outcomes, results showed.
Adam J. Olszewski
Although guidelines from the early 2000s recommended the combination for Hodgkin’s lymphoma, clinicians may be concerned about the effects of radiation therapy, Adam J. Olszewski, MD, assistant professor at Alpert Medical School of Brown University, and colleagues wrote.
The researchers sought to identify trends that impacted the choice between combined-modality therapy vs. chemotherapy alone for patients with classic Hodgkin’s lymphoma. They also assessed how these therapies impacted outcomes.
“Clinical trials showed conflicting results when combined-modality therapy was compared with chemotherapy alone, although there is a great interest in minimizing the amount of treatment for early-stage Hodgkin’s lymphoma,” Olszewski told HemOnc Today. “Because of relative equipoise with regard to treatment choice, this was an ideal setting to use real-life data from the community to evaluate how decisions are made and what the subsequent outcomes are with either strategy.”
Olszewski and colleagues used the National Cancer Data Base to evaluate data from 20,600 patients treated with combined-modality therapy (49.5%) or chemotherapy alone (50.5%) between 2003 and 2011. More than half of the population were women (51.3%), and the majority (58.8%) were aged younger than 40 years at diagnosis.
The rate for the utilization of combined-modality therapy declined from 59.4% in 2003 to 45.2% in 2011. The decreased use of combined-modality therapy was most significant in women aged younger than 30 years, whereas the decrease was not significant for women aged 50 years and older and men aged 70 years and older.
The use of combined-modality therapy was less common in patients with B symptoms, subdiaphragmatic tumors or lymphocyte-depleted histology.
Patients also were less likely to receive combined-modality therapy if they were black (OR=0.84; 95% CI, 0.75-0.95), uninsured (OR=0.72; 95% CI, 0.64-0.82) or if they lived more than 50 miles away from a treatment facility (OR=0.75; 95% CI, 0.66-0.86). Combined-modality therapy was used less frequently in academic and research facilities than in community centers (OR=0.81; 95% CI, 0.69-0.96).
Adjusted analyses indicated patients who received both chemotherapy and radiation experienced improved OS (HR=0.61; 95% CI, 0.53-0.7) and relative survival (HR=0.42; 95% CI, 0.33-0.54) compared with patients who received chemotherapy alone.
“The data suggest that clinicians did not follow guidelines as were set in 2003 to 2006 and the widespread abandonment of combined-modality therapy in the United States may lead to suboptimal outcomes,” Olszewski said. “Oncologists should have a thorough discussion with their patients about risks of longer course of chemotherapy vs. a brief chemotherapy with lower-dose radiation. The widespread fear of secondary cancers may not be as relevant with the modern techniques of radiation delivery.”
These data suggest clinical trials will play an extremely important role moving forward, according to researchers.
“It is clear that physicians and patients are not comfortable with combined modality as a standard of care,” Olszewski said. “But rather than pursuing a suboptimal treatment strategy, I believe a better way to change the standard is to bring the new breakthrough advances for refractory Hodgkin’s lymphoma into frontline clinical trials — particularly the drug-antibody conjugates and the novel immunotherapy approach. We should strongly support clinical trials in Hodgkin’s lymphoma, especially considering that the US has historically lagged behind the rest of the world in this field.” – by Alexandra Todak
Adam J. Olszewski, MD, can be reached at The Cancer Center at Memorial Hospital of Rhode Island, 111 Brewster St., Pawtucket, RI 02860; email: mailto:adam.olszewski@brown.edu.
Disclosure: One researcher reports a consultant/advisory role with and research funding from GlaxoSmithKline, Millennium Pharmaceuticals and Otsuka Pharmaceuticals.
Click Here to Manage Email Alerts