Using positron emission tomography (PET) imaging to guide chemotherapy may help to improve progression-free survival (PFS) for patients with advanced Hodgkin lymphoma (HL), according to a study conducted by the Southwest Oncology Group, Eastern Cooperative Oncology Group, and the AIDS Malignancy Consortium.
The survival of patients with HL has significantly improved in recent years, due in large part to more effective methods of imaging, diagnosis, and staging. Traditionally, PET scans have been used to identify cancer in patients. Now, in a study published in the Journal of Clinical Oncology, researchers investigated the utility of PET imaging to guide response-adapted therapy for patients with advanced HL.
Researchers led by Oliver W Press, Fred Hutchinson Cancer Research Center (Seattle, WA), conducted a trial that included 331 patients with HL, all of whom received two rounds of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), the standard chemotherapy regimen for the treatment of HL. Patients then received a PET scan after completing their initial ABVD treatment. After receiving their scans, a total of 270 patients (82%) were PET-negative; these patients received the final four cycles of ABVD. The other 60 PET-positive patients (18%) were registered for the second part of the study, in which they were scheduled to receive a more intense chemotherapy regimen called eBEACOPP.
eBEACOPP is a seven-drug combination commonly used in Europe. Although some studies have suggested it might be associated with a higher cure rate than AVBD, it is also significantly more toxic, with a large number of patients experiencing infertility, heart or lung damage, and an increased chance of developing secondary cancers such as leukemia. Six PET-positive patients declined to continue participation because of reluctance to receive eBEACOPP.
In the ABVD arm of the study, 96% of patients achieved complete remission, with the other 4% being considered partial responders because they did not submit to follow-up bone marrow biopsies. In addition, 2-year PFS was 82%.
As expected, toxicity was significantly worse in the eBEACOPP group (rate of grade 4 or 5 events, 85.7%) than in the ABVD group (rate of grade 4 or 5 events, 36.7%). However, in the eBEACOPP arm, 55% of patients achieved complete response, 38% achieved partial response, and 5% were considered to have stable disease. Two-year PFS was 64%, greatly exceeding the predetermined study goals.
Therefore, researchers concluded that response-adapted therapy based on PET imaging could be used to improve PFS in patients with HL.
