In a nutshell
This study looked at changing treatment intensity after a PET scan for patients with advanced stage Hodgkin lymphoma. The authors concluded that reducing treatment intensity for patients with a negative PET scan can reduce negative side effects and improve long-term outcomes.
Some background
Advanced stage Hodgkin lymphoma (HL) can be cured with modern treatment. One such treatment is the chemotherapy combination escalated BEACOPP (eBEACOPP; bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). Current research focuses on reducing treatment intensity to reduce later negative side effects.
PET scans (positron emission tomography) have made it possible to assess the response to treatment. This could possibly be used to determine if a patient should have their treatment reduced or intensified. A negative PET scan indicates a patient may be eligible for treatment reduction. A positive PET scan indicates a patient may benefit from treatment intensification. More research is needed to determine if treatment reduction or intensification based on PET scan results is effective foPubMedr patients with advanced stage HL.
Methods & findings
1,945 patients were recruited for this study. 940 patients had a positive PET scan after 2 cycles of eBEACOPP. 217 were randomized to 8 additional cycles of eBEACOPP (standard). 217 were randomized to 8 additional cycles of eBEACOPP plus rituximab (intensified). 506 received 6 cycles of eBEACOPP. 1,005 patients had a negative PET scan. 504 patients were randomized to receive 6-8 cycles of eBEACOPP (standard). 501 patients were randomized to receive 4 cycles of eBEACOPP (reduced). The average length of follow-up for the whole group was 60 months.
The 5-year progression free survival rate (time from treatment to disease progression) for patients with a positive PET scan was not significantly different between standard eBEACOPP (89.7%) and intensified eBEACOPP plus rituximab (88.1%).
The 5-year progression free survival rate for PET negative patients treated with standard eBEACOPP was 90.8%. This was not significantly different for patients treated with reduced eBEACOPP (92.2%).
PET negative patients treated with reduced eBEACOPP had fewer negative side effects compared to patients treated with stamdard dose eBEACOPP. 8% of patients treated with reduced eBEACOPP got a severe infection compared to 15% of standard dose patients. 8% of reduced eBEACOPP patients experienced organ side effects compared to 18% of standard dose patients.
In total, 10 patients died due to treatment related causes. 6 PET negative standard dose eBEACOPP patients died. 3 PET positive intensified eBEACOPP patients died. 1 PET positive standard dose eBEACOPP patient died.
The bottom line
The study concluded that reducing treatment intensity after a negative PET scan reduces treatment related side effects, and continuing standard dose treatment is effective for patients with a positive PET scan.
Published By :
Lancet (London, England)
Date :
Oct 20, 2017
