{"entity":{"id":"rathl","kind":"trial","name":"RATHL","aka":[],"tldr":"Showed that patients whose PET scan is clear after two cycles can safely drop bleomycin and its lung toxicity.","summary":"RATHL, trial NCT00678327 sponsored by the UK NCRI and Cancer Research UK and published in the New England Journal of Medicine in 2016, showed that patients with advanced Hodgkin lymphoma whose PET scan is clear after two cycles can safely drop bleomycin and its lung toxicity. It enrolled 1,214 patients, randomised those with a negative interim PET to continue ABVD or switch to AVD, met its non-inferiority endpoint on progression-free survival with fewer pulmonary events, and escalated PET-positive patients to BEACOPP. OnCo links it to Hodgkin lymphoma, PET-adapted therapy, FDG PET, the Deauville scale term, Cancer Research UK, Peter Johnson and the bleomycin caution pairing, and it is concordant with GHSG HD18. It established interim PET as a treatment-steering tool, and whether PET can guide even deeper de-escalation is the open question.","status":"positive","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT00678327","url":"https://clinicaltrials.gov/study/NCT00678327"}],"tags":[],"related":["lymphoma-roadmap","hd18","ahl2011","eortc-h10"],"cancers":["hodgkin-lymphoma","advanced-stage-classical-hodgkin-lymphoma"],"sections":[],"technologies":["pet-adapted-therapy","fdg-pet"],"targets":[],"drugs":["bleomycin"],"companies":[],"institutions":["cruk"],"pathways":[],"terms":["deauville-score"],"trials":[],"people":["peter-johnson"],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT00678327","phase":"3","setting":"Advanced Hodgkin lymphoma: interim-PET-guided omission of bleomycin (AVD) vs continued ABVD","sponsor":"UK NCRI / Cancer Research UK","result":"3-year PFS 85.7% (ABVD) vs 84.4% (AVD); bleomycin safely omitted.","started":"2008-08-29","startedType":"actual","yearReported":2016,"enrolled":1214,"enrolledBasis":"registry","outcomes":[{"endpoint":"Progression-free survival at 3 years (PET2-negative)","primary":true,"unit":"%","arms":[{"name":"ABVD","n":470,"value":85.7},{"name":"AVD","n":465,"value":84.4}],"source":"https://www.nejm.org/doi/full/10.1056/NEJMoa1510093"}],"replication":"Concordant with GHSG HD18 (shortened BEACOPP after negative PET2)."},"route":"/trials/rathl/","neighbours":{"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"lymphoma-roadmap","kind":"roadmap","name":"Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting","route":"/roadmaps/lymphoma-roadmap/"}],"trial":[{"id":"ahl2011","kind":"trial","name":"AHL2011","route":"/trials/ahl2011/"},{"id":"eortc-h10","kind":"trial","name":"EORTC/LYSA/FIL H10","route":"/trials/eortc-h10/"},{"id":"hd18","kind":"trial","name":"GHSG HD18","route":"/trials/hd18/"}],"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"}],"technology":[{"id":"fdg-pet","kind":"technology","name":"FDG PET","route":"/technologies/fdg-pet/"},{"id":"pet-adapted-therapy","kind":"technology","name":"PET-adapted (response-adapted) therapy","route":"/technologies/pet-adapted-therapy/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"}],"institution":[{"id":"cruk","kind":"institution","name":"Cancer Research UK","route":"/institutions/cruk/"}],"term":[{"id":"lymphoma-tx-uk-versus-us","kind":"term","name":"British and American lymphoma practice: where they differ, and why","route":"/terms/lymphoma-tx-uk-versus-us/"},{"id":"deauville-score","kind":"term","name":"Deauville five-point scale","route":"/terms/deauville-score/"},{"id":"lymphoma-decision-beacopp-or-abvd","kind":"term","name":"Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed","route":"/terms/lymphoma-decision-beacopp-or-abvd/"},{"id":"lymphoma-tx-hodgkin-late-effects","kind":"term","name":"Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them","route":"/terms/lymphoma-tx-hodgkin-late-effects/"}],"person":[{"id":"peter-johnson","kind":"person","name":"Peter Johnson","route":"/people/peter-johnson/"}],"pairing":[{"id":"bleomycin-omission-caution","kind":"pairing","name":"Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF","route":"/pairings/bleomycin-omission-caution/"}],"paper":[{"id":"paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019","kind":"paper","name":"PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study","route":"/key-papers/paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019/"},{"id":"paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016","kind":"paper","name":"RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma","route":"/key-papers/paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016/"}]}}