Stanford V yields excellent outcomes in bulky, advanced HL

LOS ANGELES-When given as intended with radiation therapy, the dose-intense Stanford V regimen is well-tolerated, safe, and effective for treating bulky or advanced Hodgkin lymphoma, based on the experience of Memorial Sloan-Kettering Cancer Center. The results confirm the excellent outcomes reported by Horning et al (J Clin Oncol 20:630-637, 2002).

“As we know, ABVD is the standard of care for advanced-stage Hodgkin lymphoma, usually given over 6 months,” lead author Sophia Edwards-Bennett, MD, PhD, said at the 2007 ASTRO annual meeting (abstract 31). “However, over the past few years, there have been several therapeutic regimens that have been introduced with the goal of increasing efficacy and reducing toxicity. The Stanford V combined-modality regimen is one such innovation.”

Accumulating evidence points to the criticality of the radiation therapy component of this regimen, she further noted.

Dr. Edwards-Bennett and her colleagues determined outcomes in 126 consecutive patients with locally extensive and/or advanced-stage Hodgkin lymphoma treated at Memorial Sloan-Kettering with the Stanford V regimen between June 1995 and May 2002. The majority of patients (88%) received radiation as specified by the regimen’s guidelines.

With a median follow-up of 69 months, the estimated 12-year rates of freedom from treatment failure and overall survival were 79% and 90%, respectively, Dr. Edwards-Bennett said.

The rate of freedom from treatment failure was significantly better for patients with stage I-II disease than for those with stage III-IV disease, but overall survival did not differ by stage.

Both rates were significantly better for patients with an international prognostic score (IPS) of less than 4 than for patients with a higher IPS. In a multivariate analysis, an IPS of 4 or greater and bone marrow involvement both independently predicted a higher risk of treatment failure and death, she noted.

Among the 26 patients with a treatment failure, 25 underwent salvage therapy, with success in 15 cases, for a 6-year rate of freedom from second relapse of 58%.

One patient developed radiation pneumonitis and three developed secondary malignancies (nonfatal papillary thyroid carcinoma, nonfatal anaplastic large-cell lymphoma of the skin, and fatal AML).

“We did not formally assess reproductive function; however, we were able to preserve fertility in some of our patients,” she said. Specifically, 17 pregnancies were recorded for the cohort, one set of twins was conceived without fertility drugs, and a male patient conceived two children without sperm banking.

Dr. Edwards-Bennett noted that an intergroup trial comparing Stanford V and ABVD is ongoing, “and we anxiously await those results.”

VantagePoint Radiation therapy is a critical component of Stanford V

LENA SPECHT, MD, PhD - “It must be remembered that the Stanford V regimen is not a full-chemotherapy treatment-it is a combined-modality regimen with less chemotherapy but radiation therapy to 90% of patients. And this is, of course, extremely important to be aware of if you are using the regimen,” said Dr. Specht, of the Copenhagen University Hospital, Denmark.

She noted that in an earlier Italian intergroup trial finding poorer results for Stanford V, patients did not receive radiation therapy according to the regimen’s guidelines, which call for involved-field radiation therapy to 36 Gy to sites initially measuring 5 cm or greater and to macroscopic splenic disease.

“The paper presented today confirms that given as specified-as a combined-modality regimen with the specified chemotherapy and the specified radiotherapy-the Stanford V regimen achieves excellent results,” she concluded.