Hodgkin Lymphoma: Intensifying Treatment With Rituximab After PET

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Adjusting treatment dose after 2 courses of first-line therapy based on a positive PET scan does not improve progression-free survival.
Adjusting treatment dose after 2 courses of first-line therapy based on a positive PET scan does not improve progression-free survival.

Adjusting treatment dose after 2 courses of first-line therapy based on a positive PET scan does not improve progression-free survival (PFS) among patients with advanced stage Hodgkin lymphoma, according to a study published in The Lancet Oncology.1

It is unclear under what conditions to intensify treatment for patients with Hodgkin lymphoma after initial chemotherapy. For this phase 3 study (ClinicalTrials.gov Identifier: NCT00515554), researchers evaluated whether intensifying treatment for PET-positive patients post-2 courses of first-line therapy would improve PFS.

Of 1100 patients who received 2 cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP), 440 PET-positive patients were randomized to receive BEACOPP (220 patients) or BEACOPP + rituximab (220 patients).

Estimated 3-year PFS rates were 91.4% and 93% in the BEACOPP and BEACOPP + rituximab groups, respectively. Grade 3-4 adverse events occurred in at least 95% of patients from both groups; 1 patient from the BEACOPP group and 3 patients from the rituximab group died from treatment-related adverse events.

The authors concluded that adding rituximab to BEACOPP does not improve PFS among patients with Hodgkin lymphoma, and further that PET after BEACOPP “does not identify a high-risk patient cohort.” Results from PET-negative patients are forthcoming.

RELATED: Hodgkin Lymphoma Survivors Treated With Anthracyclines Have 3-fold Risk of Heart Failure

It is unclear, however, whether the second conclusion is warranted. The low number of progression events within this study (and the absence of data from PET-negative patients) may limit the validity of the conclusion that PET has a low prognostic value in this setting.

Reference

  1. Borchmann P, Haverkamp H, Lohri A, et al. Progression-free survival of early interim PET-positive patients with advanced stage Hodgkin's lymphoma treated with BEACOPPescalated alone or in combination with rituximab (HD18): an open-label, international, randomised phase 3 study by the German Hodgkin Study Group. Lancet Oncol. 2017 Feb 21. doi: 10.1016/S1470-2045(17)30103-1 [Epub ahead of print]

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