Changes in treatment intensity after early PET scan in Hodgkin lymphoma

This study examined whether an early PET scan could identify patients who needed a different intensity of treatment. The authors concluded that patients who were switched to an increased intensity therapy after a positive early PET scan had better outcomes than patients who were treated as usual after a positive early PET scan. 

Hodgkin lymphoma (HL) is generally considered a curable disease. However, treatments for HL can lead to late complications. Studies are looking into ways to reduce treatment intensity but still cure patients. To do this, patients who are responding very well to first-line therapies need to be identified.

However, some patients will not respond to first-line therapy. These patients also need to be identified as early as possible in order to increase treatment intensity. Positron emission tomography (PET) scans can help to predict outcome after two cycles of treatment. It is not clear whether the results of an early PET (ePET) scan can be used to adjust treatment intensity.

This study examined the use of ePET results to either reduce or increase the intensity of treatment depending on how well the patient is responding.

1,925 patients received early PET scans after two rounds of ABVD chemotherapy. A positive ePET indicates that there is still cancer activity. A negative ePET does not detect cancer activity. Patients were randomly assigned to one of two groups. 954 patients received standard care (continuing AVBD chemotherapy and radiation), regardless of the ePET result. 971 patients received experimental therapy. In patients with a negative ePET, treatment intensity was reduced (continued ABVD chemotherapy without radiation). In patients with a positive ePET, treatment intensity was increased (the chemotherapy combination escalated BEACOPP plus radiation).

In patients who had positive ePET scans, those who received experimental treatment had better outcomes. The 5-year progression free survival (time from treatment to progression of disease) increased from 77.4% in the standard care group to 90.6% in the increased intensity group.

In patients who had negative ePET scans, those who received standard treatment had better outcomes than patients who had reduced treatment intensity.

The authors concluded that patients who have positive ePET scans have better survival outcomes when treated with increased intensity therapy, and patients who have negative ePET scans have better survival outcomes when treated with standard intensity therapy.