Last year in the UK over 60,000 cancer patients enrolled on clinical trials aimed at improving cancer treatments and making them available to all.
A trial looking at PET scans and treatment for Hodgkin lymphoma (RATHL)
Please note - this trial is no longer recruiting patients. We hope to add results when they are available.
Doctors usually treat Hodgkin lymphoma with either chemotherapy or radiotherapy, or a combination of both. Most people have ABVD chemotherapy for 6 to 8 months. Many people are cured with this. But some people need stronger treatment, and others could be cured with less treatment.
One of the drugs included in ABVD is called bleomycin. It can cause lung damage and doctors want to see if some people can safely have less of it. Until now, it has been difficult for doctors to tell who could have less treatment and who needs more. A type of scan called a PET scan may help by showing if there are areas of active cancer. This can tell doctors how you are responding to treatment. If the scan shows there is still active lymphoma, it is called a positive scan. If there is no abnormal activity, it is a negative scan.
In this trial, you have a PET scan early in your treatment. Depending on the results of the scan, doctors can change the rest of your treatment. The aims of the trial are to find out if
- PET scanning after 2 cycles of ABVD is a reliable way of making decisions about treatment
- It is safe for people who have a negative scan to stop having bleomycin
- More intensive chemotherapy helps people who have a positive scan
Who can enter
You can enter this trial if you
- Have been diagnosed with Hodgkin lymphoma that is stage 2B, 3 or 4 (you may be able to take part if you have stage 2A, the trial doctor will advise you about this)
- Have satisfactory blood test results
- Are well enough to take part in the trial (performance status 0, 1, 2 or 3)
- Are willing to use reliable contraception during the trial if there is any chance you or your partner could become pregnant
- Are at least 18 years old
- Have access to an approved PET-CT scanner
You cannot enter this trial if you
- Have Hodgkin lymphoma that is affecting your brain or spinal cord
- Have already had treatment for Hodgkin lymphoma
- Have another type of cancer, apart from non melanoma skin cancer or squamous cell cancer of the cervix that has been completely removed, or any other cancer if you have been free of the disease for at least 5 years
- Have heart problems
- Have diabetes that is not well controlled
- Have any other medical condition that is not well controlled with medicine
- Are known to be HIV, Hepatitis B or Hepatitis C positive
- Are pregnant or breastfeeding
If the PET scan is negative, your lymphoma has responded well to the treatment. You will be put into one of two treatment groups by a computer. This is called
- Group 1 will have 4 more cycles of ABVD
- Group 2 will have 4 more cycles of treatment without the bleomycin (AVD)
If you have a positive PET scan, you will change to a more intensive type of chemotherapy called BEACOPP. This is made up of the drugs doxorubicin, cyclophosphamide, etoposide, procarbazine, bleomycin, vincristine and prednisolone.
There are 2 different ways you can have BEACOPP. One is called BEACOPP 14 and the other is BEACOPP escalated. They both work equally well and the exact treatment you have will depend on the hospital where you have your treatment.
If you have BEACOPP 14, you have chemotherapy in 2 week (14 day) cycles of treatment. After 4 cycles (8 weeks) of treatment, you have another PET scan. Depending on the results of the scan, you will either have 2 more cycles of the same treatment or your doctor will talk to you about changing to a different treatment.
If you have BEACOPP escalated, you have the same drugs, but in 3 week cycles of treatment, with higher doses of some of the drugs. After 3 cycles (9 weeks) of treatment, you have another PET scan. Depending on the results of the scan, you will either have one more cycle of the same treatment, or your doctor will talk to you about changing to a different treatment.
Some people will have radiotherapy as well. If the PET scan after 2 cycles of treatment was negative, it is unlikely that you will need to have radiotherapy. But your doctor will discuss this with you.
As part of this trial, the research team will ask for a sample of the
You will see the trial team and have some tests before you start treatment. The tests include
- Physical examination
- Blood tests
Lung function tests
- Bone marrow test
- PET-CT scan
- Heart trace (
- Heart scan (
- CT scan
- Pregnancy test (if there is any chance you could be pregnant)
The number of hospital visits will depend on which chemotherapy you have and whether or not you have radiotherapy. If you do have radiotherapy, you have treatment every day (Monday to Friday) for 3 to 4 weeks.
You see the doctor and have blood tests before each cycle of chemotherapy. You have a CT scan 3 months and 12 months after your treatment. When you finish your treatment, you will see the trial team
- Every 3 months for the first year
- Every 4 months in the 2nd year
- Every 6 months in the 3rd year
- Once a year after that
The side effects of ABVD or BEACOPP chemotherapy include
- Tiredness (fatigue)
- A drop in the number of white blood cells causing an increased risk of infection
- Hair loss
- Changes to the skin or nails
- Numbness and tingling in the hands and feet (peripheral neuropathy)
BEACOPP can also cause a sore mouth and bladder irritation.
Chemotherapy for Hodgkin lymphoma may have a permanent effect on your fertility. It is important to talk to your doctor about this before you start treatment.
The side effects of radiotherapy depend on which part of the body is being treated. We have more information about side effects of radiotherapy for Hodgkin lymphoma, ABVD, cyclophosphamide, etoposide, procarbazine, prednisolone and vincristine.
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.
Professor Peter Johnson
Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
National Institute for Health Research Cancer Research Network (NCRN)
This is Cancer Research UK trial number CRUK/07/033.