Interim FDG-PET Response-Adapted Therapy May Be of Benefit in Hodgkin Lymphoma
In a phase II US Intergroup trial (Southwest Oncology Group S0816) reported in the Journal of Clinical Oncology, Press et al found that early interim fluorodeoxyglucose positron-emission tomography (FDG-PET) to guide response-adapted therapy resulted in progression-free survival substantially higher than expected among patients with stages III to IV Hodgkin lymphoma switching therapy based on PET response. The trial was a collaborative effort of the Southwest Oncology Group, the Cancer and Leukemia Group B/Alliance, the Eastern Cooperative Oncology Group, and the AIDS Malignancy Consortium.
Study Details
In the trial, 336 patients underwent FDG-PET scanning (PET2) after two initial cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Patients who were PET2-negative on central review (Deauville score 1–3) received an additional four cycles of ABVD; PET2-positive patients (Deauville score 4–5) were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for six cycles. Patients had a median age of 32 years (range = 18–60 years), 52% had stage III and 48% had stage IV disease, and the International Prognostic Score was 0–2 in 49% and 3–7 in 51%.
Outcomes
Among 331 evaluable patients, 271 patients (82%) had negative PET2, and 60 (18%) had positive PET2. Among the 60 PET2-positive patients, 49 switched to eBEACOPP, and 11 elected not to switch therapy.
After a median follow-up of 39.7 months, estimated 2-year overall survival was 98%, and 2-year progression-free survival was 79% among all patients. Estimated 2-year progression-free survival was 82% (95% confidence interval [CI] = 77%–86%) among the 271 PET2-negative patients and 64% (95% CI = 50%–75%) among the 60 PET2-positive patients. Outcomes were similar among the 270 PET2-negative and 49 PET2-positive patients who followed the study treatment protocol.
Nonhematologic and hematologic toxicities were more common in the eBEACOPP group vs the continued ABVD group.
The investigators concluded: “Response-adapted therapy based on interim PET imaging after two cycles of ABVD seems promising with a 2-year [progression-free survival] of 64% for PET2-positive patients, which is much higher than the expected 2-year [progression-free survival] of 15% to 30%.”
The study was supported by the National Cancer Institute (NCI), the NCI Community Oncology Research Program, and the National Institutes of Health.
Oliver W. Press, MD, PhD, of the Fred Hutchinson Cancer Research Center, is the corresponding author of the Journal of Clinical Oncology article.
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