A trial looking at treatment for children and young people with Hodgkin lymphoma (EuroNet-PHL-C1)
Cancer type:
Status:
Phase:
This trial compared different treatments for Hodgkin lymphoma (HL) to try and lower the risk of long term side effects. It was for children and young people who had recently been diagnosed with HL.
The trial was supported by Cancer Research UK. It was open for people to join between 2007 and 2013. The team published some results in 2022 and 2023.
More about this trial
When this trial was done, doctors usually treated Hodgkin lymphoma with chemotherapy and radiotherapy. These treatments often work very well. But they can cause long term side effects.
Doctors thought that some people may be having radiotherapy without really needing it. They wanted to find out if it’s safe for people to not have radiotherapy.
This trial was for children and young people up to the age of 18.
There were 3 treatment groups:
- group 1 was for people with early stage lymphoma
- group 2 was for people with intermediate stage lymphoma
- group 3 was for people with advanced stage lymphoma
Everyone taking part had 2 cycles of chemotherapy to begin with. They had a combination called OEPA. This is vincristine, etoposide, prednisolone (a steroid) and doxorubicin.
They then had a scan. The treatment they had next depended on how well OEPA had worked and which group they were in:
People in group 1:
- had radiotherapy if OEPA hadn’t worked as well as they’d hoped
- didn’t have radiotherapy if OEPA had worked well
- didn’t have any more chemotherapy
People in group 2:
- had radiotherapy if OEPA hadn’t worked as well as they’d hoped
- didn’t have radiotherapy if OEPA had worked well
- had 2 more cycles of either COPP or COPDAC chemotherapy
People in group 3:
- had radiotherapy if OEPA hadn’t worked as well as they’d hoped
- didn’t have radiotherapy if OEPA had worked well
- had 4 cycles of either COPP or COPDAC chemotherapy
COPP is a combination of cyclophosphamide, vincristine, prednisolone and procarbazine.
COPDAC is a combination of cyclophosphamide, vincristine, prednisolone and dacarbazine.
The main aims of this trial were to find out if:
- it was ok for people to not have radiotherapy
- COPDAC worked as well as COPP
- COPDAC caused fewer people to have
fertility 
problems
Summary of results
This trial showed that it is safe for some people to not have radiotherapy, and to have COPDAC instead of COPP.
Results
A total of 2,102 children and young people joined this trial:
- 737 with early stage lymphoma in group 1
- 455 with intermediate stage lymphoma in group 2
- 910 with advanced stage lymphoma in group 3
They all had 2 cycles of OEPA first. Across all the groups, about 6 out of 10 people (60%) went on to have radiotherapy. And about 4 out of 10 people (40%) did not.
The team looked at how many people hadn’t had what they call an ‘event’ after 5 years. They call this event free survival. It means that their lymphoma had not come back or got worse, they hadn’t been diagnosed with cancer somewhere else and had not died.
The team found it was around 9 out of 10 in all groups:
- 89% for those who had radiotherapy in group 1
- 87% for those who didn’t have radiotherapy in group 1
- 90% for those who had COPP in groups 2 and 3
- 86% for those who had COPDAC in groups 2 and 3
Side effects
Most people taking part had at least one side effect. Many were mild or didn’t last long. Some people had more severe side effects. But no one decided to stop treatment because of the side effects they were having.
Group 1 side effects
The most common side effects included:
- a drop in
red blood cells - an increase in proteins (enzymes) produced by the
liver - being sick
The most common of the more severe side effects was a drop in .
The team looked at how many people had problems after treatment. They found it was a bit higher in those who had radiotherapy:
- 2 out of every 10 people (20%) who had radiotherapy
- less than 1 out of every 10 people (3%) who didn’t have radiotherapy
For about 7 out of every 10 people (68%), the thyroid changes were mild and didn’t need treatment.
Groups 2 and 3 side effects
People having COPP had more side effects than those having COPDAC. The most common side effects included:
- a drop in red blood cells
- a drop in white blood cells
The team also looked at fertility in those taking part who had been through puberty. They measured hormone levels and did sperm analysis.
They found that fewer people who had COPDAC had fertility issues compared to those who had COPP.
Conclusion
The research team concluded that it is safe for people not to have radiotherapy if scans show that OEPA chemotherapy has worked well.
They also concluded that COPDAC worked almost as well as COPP. And caused fewer fertility issues and other side effects.
More detailed information
There is more information about this research in the references below.
Please note, the information we link to here is not in plain English. It has been written for healthcare professionals and researchers.
Response-adapted omission of radiotherapy and comparison of consolidation chemotherapy in children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma (EuroNet-PHL-C1): a titration study with an open-label, embedded, multinational, non-inferiority, randomised controlled trial
C Mauz-Körholz and others
The Lancet Oncology, 2022. Volume 23, issue 1, pages 125 – 137.
Response-adapted omission of radiotherapy in children and adolescents with early-stage classical Hodgkin lymphoma and an adequate response to vincristine, etoposide, prednisone, and doxorubicin (EuroNet-PHL-C1): a titration study
C Mauz-Körholz and others
The Lancet Oncology, 2023. Volume 24, issue 3, pages 252 – 261.
Where this information comes from
We have based this summary on the information in the articles above. This has been reviewed by independent specialists () and published in a medical journal. We have not analysed the data ourselves. As far as we are aware, the links we list above is active and the article is free and available to view.
Recruitment start:
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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.
Chief Investigator
Professor Hamish Wallace
Supported by
Cancer Research UK
Cancer Research UK Children's Cancer Trials Team
University of Birmingham
European Paediatric Hodgkin's Lymphoma Network
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer
Other information
This is Cancer Research UK trial number CRUK/08/007.
If you have questions about the trial please contact our cancer information nurses
Freephone 0808 800 4040
