PET-driven Therapy Decisions Promising for Hodgkin Lymphoma

A positron emission tomography (PET) outcomes–driven switch in therapy from doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) therapy to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) was feasible, safe, and effective among patients with advanced Hodgkin lymphoma (HL), according to a study published in the Journal of Clinical Oncology.¹

Patients treated with BEACOPP have improved outcomes compared with ABVD but also face significant adverse events. A major goal of therapy is therefore to minimize toxicity.

For the prospective phase 2 GITIL/FIL HD 0607 study (ClinicalTrials.gov Identifier: NCT00795613), researchers evaluated the outcomes of 780 patients with advanced HL assigned to undergo PET after 2 ABVD cycles. Patients with positive PET results were assigned to switch to 4 cycles of escalated BEACOPP followed by 4 additional cycles of standard BEACOPP with or without rituximab. Patients with a negative PET continued ABVD therapy, and those with a large nodal mass at diagnosis who had a complete remission with negative PET results post-chemotherapy were randomly assigned to radiotherapy or to discontinue therapy. The median follow-up was 3.6 years.

One hundred and fifty (19%) and 630 (81%) patients had positive and negative PET results, respectively.

The 3-year progression-free survival was 82% for all patients; patients with a positive PET had a 3-year PFS of 60% compared with 87% among patients with a negative PET.

No significant PFS differences were observed among patients who switched to BEACOPP with or without rituximab and patients who were randomly assigned to radiotherapy following ABVD and negative PET.

The 3-year overall survival rates were 97% for all patients, 99% among patients with a negative PET, and 89% among patients with a positive PET.

The authors concluded “that a PET response–adapted treatment is a feasible, safe, and effective therapeutic strategy in advanced-stage HL.”

Reference

1. Gallamini A, Tarella C, Viviani S, et al. Early chemotherapy intensification with escalated BEACOPP in patients with advanced-stage Hodgkin Lymphoma with a positive interim positive emission tomography/computed tomography scan after two ABVD cycles: long-term results of the GITIL/FIL HD 0607 trial. J Clin Oncol. 2018 Jan 23. doi: 10.1200/JCO.2017.75.2543 [Epub ahead of print]