Previously untreated HL: early PET response-adapted treatment yields impressive 5-y PFS

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Takeaway

  • Significantly improved 5-y PFS was seen in patients with Hodgkin's lymphoma (HL) who switched to bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc) + involved-node radiotherapy (INRT) after positive positron emission tomography (PET) after 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). 

Why this matters

  • There is no current method for predicting which patients may benefit by sparing INRT.

Study design

  • Study of an early PET response-adapted strategy in 1950 patients with previously untreated stage I and II HL.
  • Patients were categorized by favorable/unfavorable disease per European Organisation for Research and Treatment of Cancer (EORTC) criteria.
  • All patients received 2 cycles of ABVD before early PET evaluation, with therapy thereafter based on early PET outcome.
  • Funding: Varian Medical Systems.

Key results

  • In early PET-positive patients: 5-y PFS rates were 77.4% with ABVD+INRT vs 90.6% with intensification to BEACOPPesc + INRT (HR, 0.42; P=.002).
  • In early PET-negative EORTC favorable patients: 5-y PFS rates were 99.0% with ABVD+INRT vs 87.1% with ABVD only (HR, 15.8).
  • In early PET-negative EORTC unfavorable patients: 5-y PFS rates were 92.1% with ABVD+INRT vs 89.6% with ABVD only (HR, 1.45).

Limitations

  • 18.8% of patients were early PET-positive.