Trials using interim response to titrate therapy

The Pediatric Oncology Group used a response-based therapy approach consisting of dose-dense doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) for intermediate-stage and advanced-stage patients, in combination with 21 Gy involved-field radiation therapy (IFRT).[31]

The Pediatric Oncology Group used a response-based therapy approach consisting of dose-dense doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) for intermediate-stage and advanced-stage patients, in combination with 21 Gy involved-field radiation therapy (IFRT).[31]

The dose-dense approach permitted reduction in chemotherapy exposure in 63% of patients who achieved a rapid early response on CT imaging after three ABVE-PC cycles.

The Pediatric Oncology Group used a response-based therapy approach consisting of dose-dense doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) for intermediate-stage and advanced-stage patients, in combination with 21 Gy involved-field radiation therapy (IFRT).[31]

The 5-year event-free survival (EFS) rates were comparable for rapid early responders (86%; treated with three cycles of ABVE-PC) and slow early responders (83%; treated with five cycles of ABVE-PC). All patients received 21 Gy of regional radiation therapy.

The Children's Cancer Group (CCG) (CCG-59704) evaluated response-adapted therapy featuring four cycles of the dose-intensive bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone (BEACOPP) regimen, followed by a sex-tailored consolidation, for pediatric patients with stages IIB, IIIB with bulky disease, and IV Hodgkin lymphoma.[32]

The Children's Cancer Group (CCG) (CCG-59704) evaluated response-adapted therapy featuring four cycles of the dose-intensive bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone (BEACOPP) regimen, followed by a sex-tailored consolidation, for pediatric patients with stages IIB, IIIB with bulky disease, and IV Hodgkin lymphoma.[32]

For rapid early responding girls, an additional four courses of cyclophosphamide, vincristine, procarbazine, prednisone/doxorubicin, bleomycin, vinblastine (COPP/ABV) without IFRT was given in an effort to reduce breast cancer risk.

The Children's Cancer Group (CCG) (CCG-59704) evaluated response-adapted therapy featuring four cycles of the dose-intensive bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone (BEACOPP) regimen, followed by a sex-tailored consolidation, for pediatric patients with stages IIB, IIIB with bulky disease, and IV Hodgkin lymphoma.[32]

Rapid early responding boys received two cycles of ABVD followed by IFRT.

The Children's Cancer Group (CCG) (CCG-59704) evaluated response-adapted therapy featuring four cycles of the dose-intensive bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone (BEACOPP) regimen, followed by a sex-tailored consolidation, for pediatric patients with stages IIB, IIIB with bulky disease, and IV Hodgkin lymphoma.[32]

Slow early responders received four additional courses of BEACOPP and IFRT.

The Children's Cancer Group (CCG) (CCG-59704) evaluated response-adapted therapy featuring four cycles of the dose-intensive bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone (BEACOPP) regimen, followed by a sex-tailored consolidation, for pediatric patients with stages IIB, IIIB with bulky disease, and IV Hodgkin lymphoma.[32] › Slow early responders received four additional courses of BEACOPP and IFRT.

Rapid early response (defined by resolution of B symptoms and >70% reduction in tumor volume) was achieved by 74% of patients after four BEACOPP cycles. The 5-year EFS rate among the cohort was 94% (median follow-up, 6.3 years).

The COG AHOD0031 (NCT00025259), AHOD0831 (NCT01026220), and AHOD0431 (NCT00302003) trials also used interim response to titrate therapy. The AHOD0031 trial was designed to evaluate this paradigm of care by randomly assigning patients to receive either standard or response-based therapy. For more information, see the Evolution of North American cooperative and consortium trial results section.