Topline  Presentation Points

Overview of response adaptation trial data: 

  • UK RAPID study 
    • ‘Although the non-inferiority margin was exceeded in this study, the results suggest that radiotherapy can be avoided for patients with negative PET findings’ 

Radford et al NEJM (2015) 372:17; 1598-1607

  • EORTC H10 study 
    • ‘In the F group, CMT results in better early disease control; however in the U group benefit of CMT seems to be less clinically relevant, and treatment with chemotherapy only is defensible in individual patients’ 

Andre et al (2017) JCO

Individualizing radiotherapy – late effects risks 

  • Benefits of radiotherapy in ABVD treated patients are modest but clear
  • Late effects vary widely between individuals 
    • Radiotherapy decision should be made on a patient by patient basis 
    • Assessing individualized risk benefit discussion 
      • Age, sex, disease distribution, patient wishes 
    • Involve a radiation oncologist early in the discussion 
    • It is not just the radiotherapy that is doing the damage 

Future directions 

  • RADAR Trial  
    • Aiming to increase 3y PFS from 90% to 95% by incorporating BV 
    • To target burden of RT by increasing PET negativity rate and administering it to those who are likely to benefit most (Age > 60 and baseline lesion >5 cm) 
    • Provide material for BioPet: gene expression signature being developed on RAPID material, for validation with RADAR material 
    • Plasma being banked for circulating biomarker analysis