Second International Inter-Group Study for Classical Hodgkin Lymphoma in Children and Adolescents

Study Overview
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Brief Summary
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The EuroNet-PHL-C2 trial is an international, multicentre, randomised controlled trial with the aims to reduce the indication for radiotherapy in newly diagnosed patients with classical Hodgkin lymphoma without compromising cure rates and to investigate a chemotherapy intensification randomisation in intermediate and advanced classical Hodgkin lymphoma to compensate for reduction in radiotherapy.

Detailed Description
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EuroNet-PHL-C2 is a comprehensive treatment strategy for all first line classical Hodgkin Lymphoma (cHL) patients under 18 years (under 25 years in UK, Italy and France). The overall strategy is risk stratified (defining chemotherapy) and response adapted (defining radiotherapy) to tailor the amount of treatment to the individual patient and decrease long term complications. Radiotherapy indication will be restricted. Patients with a negative PET scan after two cycles of OEPA chemotherapy (Early Response Assessment - ERA) will not receive radiotherapy. The threshold for negative PET scan at ERA shifts from the previously used Deauville 1 and 2 = negative (as in the C1 trial) to Deauville 1, 2 and 3 = negative, thereby increasing the number of negative patients without indication for RT. Chemotherapy Randomisation All intermediate (TL-2) and advanced stage (TL-3) patients will be randomised between respectively 2 or 4 standard COPDAC-28 or intensified DECOPDAC-21 consolidation chemotherapy cycles. To avoid delayed consolidation, randomisation has to be performed before ERA and as soon as the TL-assignment is confirmed by central review. Therefore two randomised sub-studies arise based on the ERA PET response: Patients with adequate response at ERA do not receive radiotherapy - a randomised controlled chemotherapy comparison to show that intensified DECOPDAC-21 consolidation chemotherapy improves EFS as compared to standard COPDAC-28 Patients with inadequate response at ERA - a randomised controlled chemotherapy-radiotherapy comparison - to show that DECOPDAC-21 combined with radiotherapy restricted to sites that remain FDG-PET positive at the end of all chemotherapy (Late response assessment - LRA) has comparable EFS compared to COPDAC-28 plus standard involved node radiotherapy as in the C1 trial. Risk stratification is refined Former treatment groups (TG) of the EuroNet-PHL-C1 trial are reassigned into treatment levels (TL) by shifting early stage patients (former TG-1) with risk factors into TL-2. Semi-quantitative 'qPET' Results of semi-quantitative qPET are formally integrated into the response assessment.

Official Title
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European Network-Paediatric Hodgkin Lymphoma Study Group (EuroNet-PHL) Second International Inter-Group Study for Classical Hodgkin Lymphoma in Children and Adolescents

Conditions
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Classical Hodgkin Lymphoma

Intervention / Treatment
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* Drug: cyclophosphamide, vincristine, prednisone, dacarbazine
* Drug: cyclo, vcr, pred, dacarb,etop and doxo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: histologically confirmed primary diagnosis of classical Hodgkin's lymphoma patients under 18 years of age on the date of written informed consent. In specialized Teenage and Young Adult (TYA) units in France, Italy and UK patients up to under 25 years of age can also be enrolled. Lower age limits will be country specific according to national laws or formal insurance requirements that may preclude very young patients. written informed consent of the patient and/or the patient's parents or guardian according to national laws negative pregnancy test within 2 weeks prior to starting treatment for female patients with childbearing potential Exclusion Criteria: prior chemotherapy or radiotherapy for other malignancies pre-treatment of Hodgkin's lymphoma (except for 7-10 days steroid pre-phase of a large mediastinal tumour) diagnosis of lymphocyte-predominant Hodgkin's lymphoma other (simultaneous) malignancies contraindication or known hypersensitivity to study drugs severe concomitant diseases (e.g. immune deficiency syndrome) known HIV-positivity residence outside the participating countries where long term follow-up cannot be guaranteed pregnancy and/or lactation patients who are sexually active and are unwilling to use adequate contraception during therapy and for one month after last trial treatment current or recent (within 30 days prior to date of written informed consent) treatment with another investigational drug or participation in another interventional clinical trial

Ages Eligible for Study
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Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: COPDAC-28<br>cyclophosphamide, vincristine, prednisone, dacarbazine; cyclophosphamide 500 mg/m2, per infusion on day 1 + 8; vincristine 1.5 mg/m2 intravenously (capping dose 2 mg) on day 1 + 8 and prednisone 40 mg/m2/day by mouth divided into 3 doses (capping dose 80 mg/day) on day 1 - 15 and dacarbazine 250 mg/m2 infusion on day 1 - 3 | Drug: cyclophosphamide, vincristine, prednisone, dacarbazine<br>* 28-day chemotherapy cycle<br>* Other names: CYC, VCR, PRED, DTIC;|
| Experimental: DECOPDAC-21<br>patients with intermediate and advanced stages will be randomized after the induction therapy to receive either COPDAC-28 standard consolidation or the intensified DECOPDAC-21. cyclophosphamide dose augmented to 625 mg/m2 and adminstered per infusion on day 1 and day 2; vincristine dose not changed; prednisone 40 mg/m2/day by mouth on day 1 - 8 (no capping dose prescribed), i.e. dose-reduction; dacarbazine dose not changed; etoposide infusion100 mg/m2/day on day 1 - 3 and doxorubicine 25 mg/m2 per infusion on day 1as additional drugs in comparison to active comparator; cycle is administered as 21 days instead of 28 days-cycle for intensification | Drug: cyclo, vcr, pred, dacarb,etop and doxo<br>* 21-day chemotherapy cycle<br>* Other names: CYC, VCR, PRED, DTIC, ETO, DOXO;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Event-free survival | Time from treatment start until relapse/progression, secondary malignancy or death | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival | Time from treatment start until death | 5 years | 
| Progression-free survival | Time from treatment start until relapse/progression or death | 5 years | 
| CTC (common toxicity criteria) grading during any individual treatment element including assessment of osteonecrosis | Toxicity assessment according to CTCAE v4.0 | 5 years | 
| Time from day of PET imaging until decision on response category at ERA or LRA, respectively | Quality of Imaging (CT,MRI and PET-CT) acquisition, | 5 years | 
| Time from last day of chemotherapy to first day of radiotherapy in patients with radiotherapy indication | Quality of chemo-and radiotherapy delivery | 5 years | 
| Time from last dose of prednisone/prednisolone in OEPA to start of the first consolidation cycle | Quality of chemotherapy delivery | 5 years |