A trial looking at PET scans and treatment for advanced Hodgkin lymphoma (RATHL)

Cancer type:

Blood cancers
Hodgkin lymphoma
Lymphoma

Status:

Results

Phase:

Phase 3

This trial was to see if PET scans could be used to make decisions about treatment for Hodgkin lymphoma.

Cancer Research UK supported this trial.

More about this trial

Hodgkin lymphoma is treated with either chemotherapy or radiotherapy or a combination of both. Most people in the UK have ABVD. This is a combination of the following chemotherapy drugs:

  • doxorubicin
  • bleomycin
  • vinblastine
  • dacarbazine

This cures many people. But some people need stronger treatment. And others might be cured with less treatment.

Researchers thought a PET scan could show doctors how well ABVD had worked. In this trial everyone had a scan after 2 months of treatment with ABVD. Depending on the results of the scan doctors changed the treatment.

  • A negative scan meant that ABVD had worked well
  • A positive scan meant that ABVD hadn’t worked quite as well

Bleomycin can cause lung damage. Doctors wanted to see if it was safe for some people to have less bleomycin. So half of the people who had a negative scan continued their treatment without bleomycin (AVD). And the others continued to have all of the drugs.

People who had a positive scan had a more intensive chemotherapy combination called BEACOPP.

The aims of the trial were to find if:

  • PET scanning after 2 treatments of ABVD was a reliable way of making decisions about treatment
  • it was safe for people who had a negative scan to stop having bleomycin
  • more intensive chemotherapy helped people who had a positive scan

Summary of results

The team found that it was safe for people who had a negative scan to stop having bleomycin. And that more intensive chemotherapy helped people who had a positive scan.

This was a phase 3 trial.

Of the 1,203 people who agreed to join, the team were able to look at the PET scans of 1,119.

For:

  • 937 people ABVD had worked well (negative scan)
  • 182 people ABVD hadn’t worked quite as well (positive scan)

People with a negative scan
For people who had a negative scan this part of the trial was randomised.

935 people out of 937 were put into 1 of 2 treatment groups at random by a computer.

  • 470 people continued to have ABVD
  • 465 people stopped having bleomycin and continued with AVD

RATHL Trial Diagram

The team looked at the number of people who were alive after 3 or more years of follow up. This is called overall survival. They found that:

  • 97 out of every 100 people (97.2%) had ABVD were alive
  • 97 out of every 100 people (97.6%) had AVD were alive

They also looked at the number of people who were alive and their lymphoma had not come back. This is called progression free survival. They found that it was:

  • 85 out of every 100 people (85.7%) for those who had ABVD
  • 84 out of every 100 people (84.4%) for those who had AVD

Because bleomycin causes lung damage the researchers particularly looked at this side effect. They found that the number of people who had lung problems such as shortness of breath was lower in the AVD group than those in the ABVD group.

The side effects were worse for people who had ABVD than for those who had AVD. These side effects included:

  • a drop in white blood cells
  • tiredness
  • high temperature (fever) when the white blood cells were low
  • shortness of breath
  • inflammation of the lung

People with a positive scan
Everyone who had a positive scan had intensive chemotherapy called BEACOPP. This was to see if the response of their lymphoma could be improved.

Previously only about 15 out of every 100 people (15%) with a positive PET scan who continued treatment with ABVD remained free from lymphoma.  

At 3 years the team found that 88 out of every 100 people (87.8%) were alive. And that 67 out of every 100 people (67.5 %) were alive and had no sign of their lymphoma.

The worst side effects of BEACOPP were:

  • a drop in white blood cells and platelets
  • extreme tiredness
  • early menopause
  • infection requiring admission to hospital for antibiotics

The trial team concluded that:

  • a PET scan could be used to make decisions about further treatment
  • stopping bleomycin for people with a negative scan reduced damage to the lungs and was safe
  • more intensive chemotherapy helped people who had positive scans

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Peter Johnson

Supported by

Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer

Other information

This is Cancer Research UK trial number CRUK/07/033.

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

1855

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Over 60,000 cancer patients enrolled on clinical trials in the UK last year.

Last reviewed:

Rate this page:

No votes yet
Thank you!
We've recently made some changes to the site, tell us what you think