Optimisation of adaptive therapy for advanced Hodgkin lymphoma

Multiple studies have established the importance of increased-dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated) in providing long-term tumour control for patients with this disease, but this treatment is associated with extended haematological toxicity in normal tissue, including myelodysplasia and secondary malignancies. Other physicians, however, argue that more aggressive upfront therapy with the option for de-escalation could lead to optimum outcomes for patients.1–4 Metabolic imaging with PET has been incorporated into multiple clinical trials of Hodgkin lymphoma with patients of all stages and risk factors. Of equal importance, the outcomes of patients who had incomplete response to induction chemotherapy were better than those seen in similar patient populations in other clinical trials where treatment dose was intensified after two cycles of standard ABVD chemotherapy.4 Casanovas and colleagues provide a platform upon which translational research in Hodgkin lymphoma can move forward at an exponential rate with worldwide participation.