Abstract:PURPOSE Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron em… Show more
“…In comparison with adult HL patients, the studies on iPET2 response adapted treatment modification in pHL are sparse. 26,[31][32][33][34] In our study, patients not achieving CR in the iPET2 scan had five times increased risk of an adverse outcome when compared with patients achieving CR. Results from several studies on the role of iPET scan in the management of pHL are varied and conflicting.…”
Section: Discussionmentioning
confidence: 48%
“…[26][27][28][29][30] In comparison with adult HL patients, the studies on interim PET scan after two cycles (iPET2) response adapted treatment modification in children are sparse. 26,[31][32][33][34] This study was conducted to ascertain the outcomes of children with HL treated with ABVD chemotherapy and to analyze various factors predicting the outcome.…”
Section: Introductionmentioning
confidence: 99%
“…26 27 28 29 30 In comparison with adult HL patients, the studies on interim PET scan after two cycles (iPET2) response adapted treatment modification in children are sparse. 26 31 32 33 34…”
Introduction Most Indian centers use Adriamycin/Bleomycin/Vinblastine/Dacarba-zine (ABVD) chemotherapy for pediatric Hodgkin lymphoma (pHL). To reduce the late toxicity, robust predictive markers are needed to risk stratify pHL patients, thereby limiting the number of chemotherapy cycles and omitting radiation for low-risk and intensifying treatment for high-risk children.
Objective This study was conducted to analyze the outcome of pHL patients treated with ABVD and various factors predicting the outcome.
Materials and Methods This retrospective study analyzed the outcome of 113 consecutive pHL children treated with ABVD chemotherapy from 11 tertiary care centers in South India from 2009 to 2019.
Results The median duration of follow-up was 2.73 years. The median age was 13 years. B symptoms are seen in 50.5% patients, bulky disease in 23%, and stage IV in 28.3%. Of 113 pHL, 69% had a positron emission tomography (PET) and 31% had computed tomography (CT)-based staging. Stage IV (37.1%) and extranodal involvement (31.2%) were seen more often with PET than with CT staging (8.5 and 2.8%, respectively). Among 64 patients with interim PET scan after two cycles (iPET2), 20.3% did not achieve complete remission (CR) and no factors were significantly associated. The 4-year event-free survival (EFS) rate of the entire cohort was 86%. The 4-year EFS rate was 93% for patients with CR in iPET2 and 52% for patients not achieving CR. The only independent predictor of low EFS was iPET2 response (p < 0.05).
Conclusion Our study confirms the prognostic role of PET scan staging and response assessment. Not achieving CR on the iPET2 scan indicates poor prognosis and warrants clinical trial enrollment for a better outcome.
“…In comparison with adult HL patients, the studies on iPET2 response adapted treatment modification in pHL are sparse. 26,[31][32][33][34] In our study, patients not achieving CR in the iPET2 scan had five times increased risk of an adverse outcome when compared with patients achieving CR. Results from several studies on the role of iPET scan in the management of pHL are varied and conflicting.…”
Section: Discussionmentioning
confidence: 48%
“…[26][27][28][29][30] In comparison with adult HL patients, the studies on interim PET scan after two cycles (iPET2) response adapted treatment modification in children are sparse. 26,[31][32][33][34] This study was conducted to ascertain the outcomes of children with HL treated with ABVD chemotherapy and to analyze various factors predicting the outcome.…”
Section: Introductionmentioning
confidence: 99%
“…26 27 28 29 30 In comparison with adult HL patients, the studies on interim PET scan after two cycles (iPET2) response adapted treatment modification in children are sparse. 26 31 32 33 34…”
Introduction Most Indian centers use Adriamycin/Bleomycin/Vinblastine/Dacarba-zine (ABVD) chemotherapy for pediatric Hodgkin lymphoma (pHL). To reduce the late toxicity, robust predictive markers are needed to risk stratify pHL patients, thereby limiting the number of chemotherapy cycles and omitting radiation for low-risk and intensifying treatment for high-risk children.
Objective This study was conducted to analyze the outcome of pHL patients treated with ABVD and various factors predicting the outcome.
Materials and Methods This retrospective study analyzed the outcome of 113 consecutive pHL children treated with ABVD chemotherapy from 11 tertiary care centers in South India from 2009 to 2019.
Results The median duration of follow-up was 2.73 years. The median age was 13 years. B symptoms are seen in 50.5% patients, bulky disease in 23%, and stage IV in 28.3%. Of 113 pHL, 69% had a positron emission tomography (PET) and 31% had computed tomography (CT)-based staging. Stage IV (37.1%) and extranodal involvement (31.2%) were seen more often with PET than with CT staging (8.5 and 2.8%, respectively). Among 64 patients with interim PET scan after two cycles (iPET2), 20.3% did not achieve complete remission (CR) and no factors were significantly associated. The 4-year event-free survival (EFS) rate of the entire cohort was 86%. The 4-year EFS rate was 93% for patients with CR in iPET2 and 52% for patients not achieving CR. The only independent predictor of low EFS was iPET2 response (p < 0.05).
Conclusion Our study confirms the prognostic role of PET scan staging and response assessment. Not achieving CR on the iPET2 scan indicates poor prognosis and warrants clinical trial enrollment for a better outcome.
“…According to Girinsky et al [166], historic radiation fields encompassed significant portions of healthy tissue, whereas modern radiation therapy techniques are able to limit radiation fields to focus on tumours identified by pre-treatment PET-CT, decreasing toxicities without compromising oncologic outcomes. For certain cancers, PET-CT is also utilised to evaluate treatment response after administration of chemotherapy [167]. This opens a new perspective for glucose-targeted drug therapies [168].…”
Section: The Warburg Effect From a Clinical Perspective: Status Quomentioning
The Warburg effect is characterised by increased glucose uptake and lactate secretion in cancer cells resulting from metabolic transformation in tumour tissue. The corresponding molecular pathways switch from oxidative phosphorylation to aerobic glycolysis, due to changes in glucose degradation mechanisms known as the 'Warburg reprogramming' of cancer cells. Key glycolytic enzymes, glucose transporters and transcription factors involved in the Warburg transformation are frequently dysregulated during carcinogenesis considered as promising diagnostic and prognostic markers as well as treatment targets. Flavonoids are molecules with pleiotropic activities. The metabolism-regulating anticancer effects of flavonoids are broadly demonstrated in preclinical studies. Flavonoids modulate key pathways involved in the Warburg phenotype including but not limited to PKM2, HK2, GLUT1 and HIF-1. The corresponding molecular mechanisms and clinical relevance of 'anti-Warburg' effects of flavonoids are discussed in this review article. The most prominent examples are provided for the potential application of targeted 'anti-Warburg' measures in cancer management. Individualised profiling and patient stratification are presented as powerful tools for implementing targeted 'anti-Warburg' measures in the context of predictive, preventive and personalised medicine.
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