On 2013 Jun 22, Martin Fenner commented:

This editorial provides a good overview of the important open questions in the treatment of Hodgkin lymphoma:

• Is radiation therapy needed and if so, who should receive it?
• Is there a role for midcycle PET scanning in treatment planning and if so, what is it?
• What about escalated BEACOPP?
• Is there any prospect for new effective therapies that might actually be an improvement over ABVD?

This editorial accompanies the report Gordon LI, 2013 of a randomized phase III trial showing no improvement of the response rate with Stanford V chemotherapy compared to standard ABVD. This report comfirms the results of an earlier phase III trial Hoskin PJ, 2009, clearly demonstrating that Stanford V is no improvement over ABVD, and that ABVD remains the standard of care.

The discussion of the role of escalated BEACOPP in advanced Hodgkin lymphoma is of particular importance, because it is the standard of care for patients up to 60 years old in Germany, but not in the US and other countries. The author follows the logic of the study Viviani et al. Viviani S, 2011 that showed higher progression-free survival for BEACOPP vs. ABVD, but similar overall survival because of salvage high-dose chemotherapy. The paper by Viviani et al. has been critizised in three comments published in the same journal (see link from PubMed page), for example because progression free survival at 5 years was the primary endpoint and no power calculation was made for the secondary endpoint overall survival.

It is positive to see a discussion of important studies on journal pages (and to make the comments available to readers without a journal subscription), but we are in the unfortunate situation that standard treatment practices for patients with advanced Hodgkin lymphoma vary between countries. If the scientific community can't agree on a standard treatment strategy (the first randomized phase III trial with BEACOPP was published in 1998 Diehl V, 1998), then the different options should at least be clearly stated in treatment guidelines, editorials, and in particular in discussions with patients about to undergo treatment.

On 2013 Jun 22, Martin Fenner commented:

This editorial provides a good overview of the important open questions in the treatment of Hodgkin lymphoma:

• Is radiation therapy needed and if so, who should receive it?
• Is there a role for midcycle PET scanning in treatment planning and if so, what is it?
• What about escalated BEACOPP?
• Is there any prospect for new effective therapies that might actually be an improvement over ABVD?

This editorial accompanies the report Gordon LI, 2013 of a randomized phase III trial showing no improvement of the response rate with Stanford V chemotherapy compared to standard ABVD. This report comfirms the results of an earlier phase III trial Hoskin PJ, 2009, clearly demonstrating that Stanford V is no improvement over ABVD, and that ABVD remains the standard of care.

The discussion of the role of escalated BEACOPP in advanced Hodgkin lymphoma is of particular importance, because it is the standard of care for patients up to 60 years old in Germany, but not in the US and other countries. The author follows the logic of the study Viviani et al. Viviani S, 2011 that showed higher progression-free survival for BEACOPP vs. ABVD, but similar overall survival because of salvage high-dose chemotherapy. The paper by Viviani et al. has been critizised in three comments published in the same journal (see link from PubMed page), for example because progression free survival at 5 years was the primary endpoint and no power calculation was made for the secondary endpoint overall survival.

It is positive to see a discussion of important studies on journal pages (and to make the comments available to readers without a journal subscription), but we are in the unfortunate situation that standard treatment practices for patients with advanced Hodgkin lymphoma vary between countries. If the scientific community can't agree on a standard treatment strategy (the first randomized phase III trial with BEACOPP was published in 1998 Diehl V, 1998), then the different options should at least be clearly stated in treatment guidelines, editorials, and in particular in discussions with patients about to undergo treatment.