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.
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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.
- 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]