US Intergroup Trial of Response-Adapted Therapy for Stage III to IV Hodgkin Lymphoma Using Early Interim Fluorodeoxyglucose–Positron Emission Tomography Imaging: Southwest Oncology Group S0816

Press, Oliver W.; Liu, Hongli; Schöder, Heiko; Straus, David J.; Moskowitz, Craig H.; LeBlanc, Michael; Rimsza, Lisa M.; Bartlett, Nancy L.; Evens, Andrew M.; Mittra, Erik; LaCasce, Ann S.; Sweetenham, John W.; Barr, Paul M.; Fanale, Michelle A.; Knopp, Michael V.; Noy, Ariela; Hsi, Eric D.; Cook, James R.; Lechowicz, Mary Jo; Gascoyne, Randy D.; Leonard, John P.; Kahl, Brad S.; Cheson, Bruce D.; Fisher, Richard I.; Friedberg, Jonathan W.

doi:10.1200/jco.2015.63.1119

Cited by 236 publications

(171 citation statements)

References 26 publications

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“…The potential survival benefit was exemplified by a study involving patients with advanced HL, where the 2-y PFS of PET-21 patients advanced to BEACOPP was measured at 64%, more than double the estimate of 15%-30% for nonadapted treatment with ABVD (24). On the other hand, the possible improvement in morbidity was illustrated by a study comparing a control arm receiving 6 cycles of BEACOPP with a response-adapted experimental arm where interim PET2 patients were deescalated to ABVD.…”

Section: Response-adapted Therapy In Hlmentioning

confidence: 99%

Response Assessment Criteria and Their Applications in Lymphoma: Part 2

et al. 2016

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the diagnostic and predictive value of interim and end-of-treatment PET in HL and NHL; (2) the role of response-adapted therapy in the clinical management of lymphoma; and (3) the newly-emerging applications of interim and end-of-treatment PET in lymphoma.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, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through January 2020.Interim and end-of-treatment PET/CT have become central to the evaluation of Hodgkin and non-Hodgkin lymphoma. This review article seeks to aid clinical decision making by providing an overview of available data on the diagnostic and prognostic value of PET/CT imaging for response assessment and pretransplant evaluation in lymphoma. The relative strengths and limitations of these techniques in various disease subtypes and clinical scenarios are explored, along with their current standards for reporting and latest developments. Particular attention is given to response-adapted therapy, which is emerging as a cornerstone of clinical management. CTandPETwi th 18 F-FDG have come to play integral roles in evaluating Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Soon after the incorporation of CT into staging and response assessment criteria, the advantages of using PET's metabolic data in conjunction with CT's structural information for these applications began to become apparent. This combination was especially helpful in the staging and restaging of lymphoma. It was shown to reliably identify the 80%-95% of posttreatment residual masses that are nonmalignant, thereby sparing patients unnecessary therapy and morbidity, and it was shown to alter staging in 20% of cases, most frequently upstaging patients by better detecting bone marrow involvement (1,2).After the integration of PET into the International Working Group criteria in 2007, PET/CT was widely adopted as a first-line imaging tool for evaluating end-of-treatment response in lymphoma (3). Subsequent studies laid the groundwork for the Deauville 5-point scale (D5PS) criteria, designed for the visual interpretation of PET scans (4). This was expanded by the Lugano guidelines, which established PET/CT as the modality of choice for staging and response assessment in 18 F-FDG-avid subtypes of lymphoma but maintained CT as the preferred tool for the small histologic subset with low or variable avidity (5). These guidelines are pa...

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Section: Response-adapted Therapy In Hlmentioning

confidence: 99%

Response Assessment Criteria and Their Applications in Lymphoma: Part 2

et al. 2016

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“…We individually criticized all 3 of these studies for these issues (27)(28)(29). On the other hand, multiple, recently published, large-scale studies (14,(24)(25)(26) unambiguously showed that (in contrast to the studies by Gallamini et al (12,13)) a high proportion of the large group of patients with negative interim 18 F-FDG PET/CT results develops disease relapse during follow-up and that, therefore, a negative interim 18 F-FDG PET/CT result cannot exclude residual disease. In other words, most relapses occur after a negative interim 18 F-FDG PET/CT result (14,(24)(25)(26).…”

Section: Replymentioning

confidence: 99%

Reply: Interim PET in Hodgkin Lymphoma: Is It So Useless?

Adams

Kwee²

2017

J Nucl Med

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More than 2,000 patients with advanced disease were included in 3 well-designed prospective trials, in which patients who-after 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)-were PET-positive (Deauville score $ 4) were escalated to BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) whereas those who were PET-negative continued with the standard regimen (4 cycles of ABVD) (1-3). The PET positivity rate using this Deauville score as the cutoff was similar across these 3 studies, as was the outcome of both PET-positive and PET-negative patients. The study of the Southwest Oncology Group (1) enrolled 336 patients, 18% of whom were PET-positive. The "Response Adapted Therapy in Advanced Hodgkin Lymphoma" study (2) enrolled 1,119 patients, 25% of whom were PET-positive. The Italian GITIL/FIL HD0607 trial (3) enrolled 773 patients, 19% of whom were PET-positive. Overall, the 2-y progression-free survival of the PET-positive patients ranged between 64% and 67%. PET-negative patients who followed the standard regimen had a 2-y progression-free survival ranging between 82% and 89%, higher than the progression-free survival of the whole population.A major advantage of this strategy is that PET-negative patients (.80% of the total population) can be spared from the adverse effects of BEACOPP. As pointed out by Adams and Kwee, none of the interim 18 F-FDG PET/CT-adapted trials that have been performed so far had a control arm; that is, none continued standard ABVD in PET-positive patients. Apart from the fact that this arm would have been ethically difficult to defend, series have found 2-y progression-free survivals of 12%-27% in advanced-stage Hodgkin lymphoma patients PET-positive after 2 ABVD cycles-much lower than the 64%-67% found when these patients were intensified with BEACOPP (4,5), with this strategy therefore clearly having an advantage in improving outcome and decreasing the number of events. This finding was further confirmed by the results of the EORTC/LYSA/FIL H10 trial (6), which included 1,950 patients with early-stage Hodgkin lymphoma randomized between an experimental arm and a standard arm. Patients PET-positive after 2 ABVD cycles had a 5-y progression-free survival of 77.4% in the experimental arm that received standard ABVD plus involved-node radiotherapy, and survival improved to 90.6% in the experimental arm that received BEACOPP escalation plus involved-node radiotherapy (hazard ratio, 0.42; 95% confidence interval, 0.23-0.74; P 5 0.002).A deescalation trial (7) in 823 patients with advanced Hodgkin lymphoma (AHL2011 LYSA trial) has also recently confirmed the major role of an interim PET-guided strategy. Patients PETnegative after 2 BEACOPP escalations were moved to ABVD. Their progression-free survival was not inferior to that of the standard arm, in which BEACOPP was continued. Thus, deescalation avoids the toxic effect of BEACOPP while producing the same outcome.In view of the cited evidence, we strongly disagree with A...

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“…66,85,86 Based on these findings, the guidelines recommend escalated BEACOPP (4 cycles) as an option for patients with a Deauville score of 4 or 5 after 2 cycles of ABVD. Patients are then restaged with PET, with observation or ISRT to initially bulky or selected PET-positive sites included as options for patients with a Deauville score of 1 to 3, and biopsy recommended for patients with a Deauville score of 4 or 5.…”

Section: Stage Iii-ivmentioning

confidence: 99%

Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

Hoppe¹,

Advani²,

Ai³

et al. 2017

J Natl Compr Canc Netw

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OverviewHodgkin lymphoma (HL) is an uncommon malignancy involving lymph nodes and the lymphatic system. Most patients are diagnosed between 15 and 30 years of age, followed by another peak in adults aged ≥55 years. In 2017, an estimated 8,260 people will be diagnosed with HL in the United States and 1,070 will die of the disease. AbstractThis portion of the NCCN Guidelines for Hodgkin lymphoma (HL) focuses on the management of classical HL. Current management of classical HL involves initial treatment with chemotherapy or combined modality therapy followed by restaging with PET/CT to assess treatment response using the Deauville criteria (5-point scale). The introduction of less toxic and more effective regimens has significantly advanced HL cure rates. However, long-term follow-up after completion of treatment is essential to determine potential long-term effects. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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US Intergroup Trial of Response-Adapted Therapy for Stage III to IV Hodgkin Lymphoma Using Early Interim Fluorodeoxyglucose–Positron Emission Tomography Imaging: Southwest Oncology Group S0816

Cited by 236 publications

References 26 publications

Response Assessment Criteria and Their Applications in Lymphoma: Part 2

Response Assessment Criteria and Their Applications in Lymphoma: Part 2

Reply: Interim PET in Hodgkin Lymphoma: Is It So Useless?

Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

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