Interim PET scan spares Hodgkin's lymphoma patients from adverse chemo

Patients with Hodgkin’s lymphoma who show negative results on PET scan do as well without a full chemotherapy regimen as similar patients who receive the usual chemo. This means an interim PET scan can save some patients from many of chemo’s adverse side effects, according to results of a study published June 23, 2016 in the New England Journal of Medicine.

Conventional chemotherapy for advanced-stage Hodgkin’s lymphoma involves a multidrug regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). However, the agent bleomycin puts patients at risk of serious pulmonary toxic effects.

For this study, the researchers investigated modifying this time-honored therapy by reducing treatment in patients with a good outlook and intensifying it for patients with the highest risk. They used an interim PET scan to identify which patients should be given which treatment.

“Knowing which patients have a more difficult-to-treat form of the disease means we can select those who need stronger chemotherapy, while sparing everyone else the severe side effects such as infertility,” said study leader Peter Johnson, MA, MD, Professor of Medical Oncology at the University of Southampton, in Southampton, UK.

“This approach, along with a reduction in the need for radiotherapy, should substantially reduce damage to healthy tissues and the risk of second cancers caused by treatments,” he noted.

Their study involved about 1,200 patients with newly diagnosed Hodgkin’s lymphoma who received two cycles of ABVD chemotherapy, and then underwent an interim PET scan. For patients with negative PET findings, the researchers randomly assigned them to continue 3 more cycles of ABVD chemotherapy either with bleomycin (ABVD group) or without bleomycin (AVD group).

Patients with positive PET findings received intensive chemotherapy with the BEACOPP regimen—bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone—along with repeat PET scanning to evaluate their outcomes.

After about three and a half years of follow-up, patients with negative PET findings who were treated without bleomycin (AVD group) had a lower incidence of pulmonary toxic effects than patients who continued with bleomycin (ABVD group), but both treatments were equally effective. In the AVD group, 3-year progression-free survival was 84.4% and overall survival was 97.6%. Patients in the ABVD group had similar rates of 85.7% for progression-free survival and 97.2% for overall survival.

For the patients with positive findings on interim PET scan, escalated BEACOPP therapy achieved a 3-year progression-free survival rate of 67.5%. This rate was substantially higher than results from a retrospective study in which patients continued ABVD, and is similar to that of other series in which patients received BEACOPP after positive findings on an interim PET scan.

“The good news is that the majority of people diagnosed with Hodgkin lymphoma can be cured—in this trial more than 95% of patients are alive after 3 years. But we worry about the long-term side effects from the treatments we use,” Dr. Johnson said. “As we’ve done in this trial, personalizing treatment based on how well it works is a major development for patients with Hodgkin lymphoma, and sets a new standard of care.”

Clickhere to watch a video from the New England Journal of Medicine that encapsulates this study.