Improving outcome after positive interim PET in advanced Hodgkin’s disease: reality vs expectation

Ziakas, Panayiotis D.; Poulou, Loukia S.

doi:10.1007/s00259-008-0840-z

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…In these studies interim PET scan is performed very early during treatment, both in limited or advanced-stage HL (Hutchings & Barrington, 2009;ClinicalTrials.gov 2007ClinicalTrials.gov , 2008aClinicalTrials.gov ,b,c, 2009). The purpose of improving outcome of PET-2 positive, ABVDtreated advanced-stage HL patients has been debated (Ziakas & Poulou, 2008) but, to our knowledge, only two studies have been published so far reporting the impact of PET responseadapted therapy in advanced-stage HL (Dann et al, 2007;Avigdor et al, 2010). In the first study patients were treated according to IPS risk-class: those with IPS of 3 or higher received two cycles of escalated BEACOPP, the others received two cycles of standard BEACOPP.…”

Section: Discussionmentioning

confidence: 99%

Early chemotherapy intensification with BEACOPP in advanced‐stage Hodgkin lymphoma patients with a interim‐PET positive after two ABVD courses

Gallamini

Patti

Viviani³

et al. 2010

Br J Haematol

134

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SummaryInterim 2-[18F]Fluoro-2-deoxy-D-glucose Positron Emission Tomography performed after two chemotherapy cycles (PET-2) is the most reliable predictor of treatment outcome in ABVD-treated Hodgkin Lymphoma (HL) patients. We retrospectively analysed the treatment outcome of a therapeutic strategy based on PET-2 results: positive patients switched to BEACOPP, while negative patients continued with ABVD. Between January 2006 and December 2007, 219 newly diagnosed HL patients admitted to nine centres were enrolled; 54 patients, unfit to receive this treatment were excluded from the analysis. PET-2 scans were reviewed by a central panel of nuclear medicine experts, according to the Deauville score (Meignan, 2009). After a median follow up of 34 months (12-52) the 2-year failure free survival (FFS) and overall survival for the entire cohort of 165 patients were 88% and 98%; the FFS was 65% for PET-2 positive and 92% for PET-2 negative patients. For 154 patients in which treatment was correctly given according to PET-2 review, the 2-year FFS was 91%: 62% for PET-2 positive and 95% for PET-2 negative patients. Conclusions: this strategy, with BEACOPP intensification only in PET-2 positive patients, showed better results than ABVD-treated historic controls, sparing BEACOPP toxicity to the majority of patients (Clinical Trials.gov Identifier NCT00877747).

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Section: Discussionmentioning

confidence: 99%

Early chemotherapy intensification with BEACOPP in advanced‐stage Hodgkin lymphoma patients with a interim‐PET positive after two ABVD courses

Gallamini

Patti

Viviani³

et al. 2010

Br J Haematol

134

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“…62,63 Limited and preliminary reports from a retrospective study 64 and a prospective trial, 65 have demonstrated an apparent advantage with respect to failure-free survival using a PET-adapted strategy as compared with the conventional treatment schedule. However, no direct randomized comparison is currently available comparing a PET response-adapted strategy versus the standard chemotherapy regimen without any alteration during treatment.…”

Section: Interim Pet Outside Clinical Trials: Problems and Interpretamentioning

confidence: 99%

Interim FDG-PET in Hodgkin lymphoma: a compass for a safe navigation in clinical trials?

Gallamini

Kostakoğlu

2012

Blood

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“…It has yet to be proven with outcome data whether a PETadapted strategy can modernize management by individualizing therapy in the HL population (50,51). This personalized treatment approach is proposed with a 2-fold objective: first, to reduce treatment intensity in patients with a negative interim PET result in order to minimize chemotherapy-or radiotherapy-induced morbidity, and second, to increase the cure rate in the high-risk population using escalation strategies aiming at better disease control.…”

Section: Recent Pet-adapted Multicenter Clinical Trials Early-stage Hlmentioning

confidence: 99%

Interim¹⁸F-FDG PET in Hodgkin Lymphoma: Would PET-Adapted Clinical Trials Lead to a Paradigm Shift?

Kostakoğlu

Gallamini

2013

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the rationale behind the design of PET-adaptive studies either in a deescalation or an escalation setting; (2) the limitations of 18 F-FDG PET/CT interpretation criteria proposed for end-therapy and interimtherapy response evaluation; and (3) the challenges involved in the use of interim PET as a surrogate for therapy response.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, participants can access this activity through the SNMMI Web site (http:// www.snmmi.org/ce_online) through July 2016.Hodgkin lymphoma (HL) is a curable disease with currently available chemotherapy regimens. Major late morbidities can potentially be avoided in most limited-stage HL patients if the treatment can be adapted to the patient's early response profile. The therapy efficacy can also be increased early during therapy in nonresponding HL patients with the addition of involved-field radiation therapy or a switch to an escalated therapy protocol, particularly in advancedstage or unfavorable-risk patients. 18 F-FDG PET is a well-established surrogate for tumor chemosensitivity early during therapy. The ongoing PET-adaptive clinical trials are testing the hypothesis that a decision can reliably be made on escalating or deescalating therapy based on interim PET results. Discussed in this review is the integral role of interim 18 F-FDG PET in HL, challenges, critical issues to improve its accuracy, and the observations from completed interim PET studies and ongoing PET-adaptive clinical trials.

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Improving outcome after positive interim PET in advanced Hodgkin’s disease: reality vs expectation

Cited by 8 publications

References 12 publications

Early chemotherapy intensification with BEACOPP in advanced‐stage Hodgkin lymphoma patients with a interim‐PET positive after two ABVD courses

Early chemotherapy intensification with BEACOPP in advanced‐stage Hodgkin lymphoma patients with a interim‐PET positive after two ABVD courses

Interim FDG-PET in Hodgkin lymphoma: a compass for a safe navigation in clinical trials?

Interim¹⁸F-FDG PET in Hodgkin Lymphoma: Would PET-Adapted Clinical Trials Lead to a Paradigm Shift?

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Improving outcome after positive interim PET in advanced Hodgkin’s disease: reality vs expectation

Cited by 8 publications

References 12 publications

Early chemotherapy intensification with BEACOPP in advanced‐stage Hodgkin lymphoma patients with a interim‐PET positive after two ABVD courses

Early chemotherapy intensification with BEACOPP in advanced‐stage Hodgkin lymphoma patients with a interim‐PET positive after two ABVD courses

Interim FDG-PET in Hodgkin lymphoma: a compass for a safe navigation in clinical trials?

Interim18F-FDG PET in Hodgkin Lymphoma: Would PET-Adapted Clinical Trials Lead to a Paradigm Shift?

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Interim¹⁸F-FDG PET in Hodgkin Lymphoma: Would PET-Adapted Clinical Trials Lead to a Paradigm Shift?