Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma

Abstract

Although the results fall just short of the specified noninferiority margin, the omission of bleomycin from the ABVD regimen after negative findings on interim PET resulted in a lower incidence of pulmonary toxic effects than with continued ABVD but not significantly lower efficacy. (Funded by Cancer Research UK and Others; ClinicalTrials.gov number, NCT00678327.).

Advanced Hodgkin’s lymphoma: End-of-treatment FDG-PET should be maintained

“…Here, we comment on results of two recently published prospective multicentre trials in which patients with advanced HL had response-adapted therapy based on interim-PET [13,14]. These trials were triggered by observational studies showing high prognostic accuracy of interim PET [15].…”

“…The 2-year PFS in interim PET-positive patients was 64% [13]. Again, in the RATHL study (stage II unfavorable, stage III and stage IV), the 3-year PFS in interim PETpositive patients who were switched from ABVD to a BEACOPP regimen was 67.5% [14]. These results are very encouraging as they show that interim PET allows a finely tuned treatment by restricting the use of BEACOPP to the 15% to 20% of patients who are PET-positive.…”

“…BEACOPP offers higher cure rates in HL, but is also associated with a higher percentage of short-term and long-term adverse effects (hematologic toxicity, infections, infertility, secondary malignancies) [17]. In the absence of randomisation, the extent of benefit from switching to BEACOPP cannot be assessed from these trials [13,14]. Also, the optimal strategy in these interim-PET-positive patients might evolve in light of the new therapeutic arsenal (targeted therapy, checkpoint inhibitors such as anti-PD-1 therapy, etc.)…”

“…In the SWOG S0816 study, which included only advanced stages, the 2-year PFS in interim PET-negative patients was 82% [13]. In the RATHL study, in which 42% of patients had stage-II disease, the 3-year PFS in interim PET-negative patients who continued on ABVD was 85.7% [14]. The outcome was influenced by initial riskgroup: 3y-PFS was 90% in stage II patients with adverse risk, 83.1% in stage III and 79.6% in stage IV patients [14].…”

“…In the RATHL study, in which 42% of patients had stage-II disease, the 3-year PFS in interim PET-negative patients who continued on ABVD was 85.7% [14]. The outcome was influenced by initial riskgroup: 3y-PFS was 90% in stage II patients with adverse risk, 83.1% in stage III and 79.6% in stage IV patients [14]. Also, the risk of failure was higher in patients with IPS (international prognostic score) ≥3 (3y-PFS of 81.7%) as compared to patients with IPS <3 (3y-PFS of 86.9%) [14].…”