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8 treatment settings, 8 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
FDG-PET/CT with Lugano staging; bone marrow biopsy no longer needed when PET is used; fertility counselling and cardiac baseline.
FDG PET is the standard PET scan. A radioactive sugar shows which tissues are burning glucose fast, which most cancers do.
Protecting the ability to have children before cancer treatment that damages eggs, sperm or the womb: sperm and egg or embryo freezing, ovarian tissue freezing, ovarian shielding and, for some breast cancers, temporary ovarian suppression.
Cardio-oncology builds heart risk assessment, monitoring and prevention into cancer care so patients can finish curative treatment without trading cancer for heart failure. It targets anthracycline and trastuzumab damage, checkpoint-inhibitor myocarditis and radiation heart disease using echocardiography, troponin tests and protective drugs; specialist clinics are concentrated in large centres.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Two cycles of ABVD with 20 Gy involved-site radiotherapy (HD10); or PET-adapted chemotherapy alone (three ABVD if PET-negative after two, RAPID and H10) accepting a small increase in relapse.
The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
Vinblastine is the vinca alkaloid in ABVD, the standard Hodgkin lymphoma regimen, and was formerly in the cisplatin combinations that first cured testicular cancer.
Dacarbazine is an older chemotherapy infusion. It was the standard treatment for advanced melanoma for decades and is the D in the ABVD regimen that cures most Hodgkin lymphoma.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
Scan after two cycles of chemotherapy; if the tumour has gone dark, give less treatment, and if not, give more. Hodgkin lymphoma pioneered this.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Four cycles of ABVD (or two escalated BEACOPP plus two ABVD) with 30 Gy involved-site radiotherapy; radiotherapy omitted in PET-negative patients after HD17.
The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
Vinblastine is the vinca alkaloid in ABVD, the standard Hodgkin lymphoma regimen, and was formerly in the cisplatin combinations that first cured testicular cancer.
Dacarbazine is an older chemotherapy infusion. It was the standard treatment for advanced melanoma for decades and is the D in the ABVD regimen that cures most Hodgkin lymphoma.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
Scan after two cycles of chemotherapy; if the tumour has gone dark, give less treatment, and if not, give more. Hodgkin lymphoma pioneered this.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Response-adapted Children's Oncology Group regimens with radiotherapy for slow responders; AHOD2131 tests brentuximab vedotin with nivolumab.
The ADC that made the modern field credible (2011), for Hodgkin lymphoma and CD30+ lymphomas.
Nivolumab was the second PD-1 blocker and is often combined with ipilimumab. Long-term data show about half of advanced melanoma patients alive at 10 years on the combination.
No headline result recorded yet.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · ECHELON-1, A+AVD arm | 91% | 82% |
| Febrile neutropenia · ECHELON-1, A+AVD arm | 19% | 19% |
| Peripheral sensory neuropathy · ECHELON-1, A+AVD arm | 65% | 10% |
| Vomiting · ECHELON-1, A+AVD arm | 33% | 3% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Colitis with ipilimumab (1+3 mg/kg) · Monotherapy pooled unless stated | 25% | 14.4% |
| Hepatitis with ipilimumab · Monotherapy pooled unless stated | 15% | 13.4% |
| Colitis · Monotherapy pooled unless stated | 2.9% | 1.7% |
| Hepatitis · Monotherapy pooled unless stated | 1.8% | 1.5% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Cardiac surveillance, breast screening from eight years after chest radiotherapy in women, thyroid checks and second-cancer awareness for life.
Cardio-oncology builds heart risk assessment, monitoring and prevention into cancer care so patients can finish curative treatment without trading cancer for heart failure. It targets anthracycline and trastuzumab damage, checkpoint-inhibitor myocarditis and radiation heart disease using echocardiography, troponin tests and protective drugs; specialist clinics are concentrated in large centres.
Low-dose breast X-ray used for screening. Newer 3D versions find more cancers with fewer false alarms.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
GHSG HD10 established the smallest combined-modality treatment that works: two cycles of ABVD followed by 20 Gy involved-field radiotherapy gave five-year freedom from treatment failure of about 93 per cent and overall survival of about 97 per cent, with no advantage from four cycles or from 30 Gy, and fewer acute adverse events at the lower intensity. Four visits of chemotherapy and a fortnight of radiotherapy cure the great majority. Whether the radiotherapy can be dropped in patients whose PET is negative has been asked twice, and both answers were the same. HD16 randomised 1,150 patients: among 628 who were PET-negative after two cycles, five-year progression-free survival was 93.4 per cent with combined-modality treatment against 86.1 per cent with ABVD alone (difference 7.3 percentage points, hazard ratio 1.78), with five-year overall survival of 98.1 and 98.4 per cent. RAPID randomised patients whose PET was negative after three cycles and found three-year progression-free survival of 94.6 per cent with radiotherapy against 90.8 per cent without, with no difference in overall survival and non-inferiority not formally shown. So omitting radiotherapy costs a few percentage points of disease control and costs nothing in survival, while avoiding a field over the heart, breasts, thyroid and lungs in a person who will live another fifty years. It is a genuine choice and it is made differently by different patients and different countries. A Deauville score of 4 on the interim PET predicts a much higher risk of failure than a score of 3, and those patients keep the radiotherapy.
The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.
Vinblastine is the vinca alkaloid in ABVD, the standard Hodgkin lymphoma regimen, and was formerly in the cisplatin combinations that first cured testicular cancer.
Dacarbazine is an older chemotherapy infusion. It was the standard treatment for advanced melanoma for decades and is the D in the ABVD regimen that cures most Hodgkin lymphoma.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
FDG PET is the standard PET scan. A radioactive sugar shows which tissues are burning glucose fast, which most cancers do.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Early-stage disease with risk factors (a large mediastinal mass, extranodal involvement, a raised erythrocyte sedimentation rate, three or four or more nodal areas, or age 50 or over depending on the criteria used) is treated with four cycles of chemotherapy and involved-site radiotherapy at 30 Gy, or with more intensive chemotherapy in place of some of it. EORTC/LYSA/FIL H10 randomised 1,950 patients and settled the PET-adapted question in both directions. In the 18.8 per cent whose PET after two cycles of ABVD was positive, switching to two cycles of escalated BEACOPP with involved-node radiotherapy raised five-year progression-free survival from 77.4 to 90.6 per cent (hazard ratio 0.42). In PET-negative patients, non-inferiority of ABVD alone could not be demonstrated in either the favourable group (99.0 against 87.1 per cent for combined-modality treatment) or the unfavourable group (92.1 against 89.6 per cent), so omitting radiotherapy again costs disease control. Brentuximab vedotin with AVD is an option for unfavourable early-stage disease in some guidelines, and AHOD2131, an international trial in patients aged 5 to 60 with stage I to II disease, is testing response-adapted brentuximab vedotin with nivolumab against standard therapy with or without radiation. That trial is the one most likely to change this row next.
The ADC that made the modern field credible (2011), for Hodgkin lymphoma and CD30+ lymphomas.
Nivolumab was the second PD-1 blocker and is often combined with ipilimumab. Long-term data show about half of advanced melanoma patients alive at 10 years on the combination.
The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.
Vinblastine is the vinca alkaloid in ABVD, the standard Hodgkin lymphoma regimen, and was formerly in the cisplatin combinations that first cured testicular cancer.
Dacarbazine is an older chemotherapy infusion. It was the standard treatment for advanced melanoma for decades and is the D in the ABVD regimen that cures most Hodgkin lymphoma.
Etoposide is a chemotherapy from the mayapple plant, essential to curing testicular cancer (BEP), treating small-cell lung cancer, lymphomas, childhood sarcomas and leukaemias, and used in transplant conditioning.
Cyclophosphamide is an alkylating chemotherapy that damages DNA in dividing cells. It is part of CHOP for lymphoma, AC for breast cancer and VAC for childhood sarcomas, clears lymphocytes before CAR-T and prevents graft-versus-host disease after transplant; bladder bleeding, infertility and secondary leukaemia are its harms.
Procarbazine (Matulane) is an old chemotherapy capsule from the MOPP regimen for Hodgkin lymphoma; it is now used mainly in the PCV combination for certain brain tumours.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
FDG PET is the standard PET scan. A radioactive sugar shows which tissues are burning glucose fast, which most cancers do.
No headline result recorded yet.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · ECHELON-1, A+AVD arm | 91% | 82% |
| Febrile neutropenia · ECHELON-1, A+AVD arm | 19% | 19% |
| Peripheral sensory neuropathy · ECHELON-1, A+AVD arm | 65% | 10% |
| Vomiting · ECHELON-1, A+AVD arm | 33% | 3% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Colitis with ipilimumab (1+3 mg/kg) · Monotherapy pooled unless stated | 25% | 14.4% |
| Hepatitis with ipilimumab · Monotherapy pooled unless stated | 15% | 13.4% |
| Colitis · Monotherapy pooled unless stated | 2.9% | 1.7% |
| Hepatitis · Monotherapy pooled unless stated | 1.8% | 1.5% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Paediatric protocols differ from adult ones in two ways that matter: they use response-adapted designs to remove radiotherapy from as many children as possible, and they avoid or limit the agents with the worst late effects in a growing body, particularly alkylating agents and chest radiotherapy. Children's Oncology Group and EuroNet protocols give a short course of multi-agent chemotherapy, assess response with PET after two cycles, and give involved-site radiotherapy only to sites that have not responded adequately. The aim is to cure more than 95 per cent of children with the smallest cumulative dose of anthracycline, alkylator and radiation they can be cured with. AHOD1331 showed the direction of travel in high-risk paediatric disease: replacing bleomycin with brentuximab vedotin gave three-year event-free survival of 92.1 per cent against 82.5 per cent (hazard ratio 0.41), with three-year overall survival of 99.3 against 98.5 per cent, similar toxicity and a similar proportion receiving radiotherapy (53.4 against 56.8 per cent). AHOD2131 is now testing brentuximab vedotin with nivolumab against standard therapy in early-stage disease across the ages of 5 to 60, which is unusual and deliberate: adolescents and young adults have historically fallen between paediatric and adult trials and done worse for it. Growth, fertility, thyroid function, cardiac function and psychological support are part of the treatment plan from the first appointment, not the end of it.
The ADC that made the modern field credible (2011), for Hodgkin lymphoma and CD30+ lymphomas.
Nivolumab was the second PD-1 blocker and is often combined with ipilimumab. Long-term data show about half of advanced melanoma patients alive at 10 years on the combination.
Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.
The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
FDG PET is the standard PET scan. A radioactive sugar shows which tissues are burning glucose fast, which most cancers do.
No headline result recorded yet.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · ECHELON-1, A+AVD arm | 91% | 82% |
| Febrile neutropenia · ECHELON-1, A+AVD arm | 19% | 19% |
| Peripheral sensory neuropathy · ECHELON-1, A+AVD arm | 65% | 10% |
| Vomiting · ECHELON-1, A+AVD arm | 33% | 3% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Colitis with ipilimumab (1+3 mg/kg) · Monotherapy pooled unless stated | 25% | 14.4% |
| Hepatitis with ipilimumab · Monotherapy pooled unless stated | 15% | 13.4% |
| Colitis · Monotherapy pooled unless stated | 2.9% | 1.7% |
| Hepatitis · Monotherapy pooled unless stated | 1.8% | 1.5% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.