Patients with advanced Hodgkin lymphoma may benefit from positron-emission tomography-computed tomography (PET-CT) testing during therapy to guide treatment, according to a study published in The New England Journal of Medicine.1
Cases of advanced Hodgkin lymphoma are treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as a standard of care, and 3-year progression-free and overall survival are typically high. It is open to question, however, whether each case of this disease requires the same intensity of treatment.
Researchers enrolled 1214 newly-diagnosed patients who were 18 years or older; each underwent a PET-CT scan at baseline and received 2 cycles of ABVD treatment. Interim PET-CT scans were then conducted on 1119 patients; the 937 (83.7%) patients who had stable or reduced disease were randomly assigned to continue ABVD or to continue without bleomycin (AVD group) for the remaining 3 cycles. The 172 patients with disease progression were assigned to receive bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP).
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Three-year progression-free and overall survival rates were as follows: ABVD: 85.7% and 97.2%; AVD: 84.4% and 97.6%; BEACOPP: 67.5% and 87.8%, respectively. There were 24 Hodgkin lymphoma-related deaths, and 62 deaths overall.
The authors concluded that results did not meet the non-inferiority margin, though patients who received AVD rather than ABVD were less likely to have pulmonary toxic effects.
- Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, et al. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin’s lymphoma [published online ahead of print June 23, 2016]. N Engl J Med. doi: 10.1056/NEJMoa1510093.