Five-year follow-up results for the S0816 trial of positron emission tomography (PET)-adapted treatment in patients with advanced-stage Hodgkin lymphoma (HL) were recently reported in Blood.

During the phase 2 S0816 trial (ClinicalTrials.gov Identifier: NCT00822120), patients with advanced-stage HL were given 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and then evaluated for response by PET scan (referred to as “PET2” at this point in treatment). A total of 336 patients were treated, and 331 had a PET2 central review.

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Patients whose PET2 results indicated complete response (CR) received another 4 cycles of ABVD. Patients whose PET2 results did not show CR had ABVD discontinued and were given further treatment with 6 cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP).

A total of 270 (82%) patients showed negative results at PET2 (Deauville score ≤ 3), which indicated CR. A total of 61 (18%) patients showed positivity on the PET scan. The 270 patients with PET2-negativity continued on ABVD, and 80% of patients with PET2-positivity were placed on eBEACOPP.

The median study follow-up duration was 5.9 years (range, 0.2-8.3). The 5-year rate of progression-free survival (PFS) was 76% (95% CI, 70%-81%) for patients showing PET2-negativity. The 5-year PFS rate was 66% (95% CI, 52%-76%) for patients showing PET2-positivity.

Although the 5-year PFS rate for PET2-negative patients was favorable, it was lower than the 2-year PFS rate, which was 82%, according to the study authors.

Overall survival (OS) at 5 years was estimated to be 94% (95% CI, 91%-96%) for the total patient population and was lower for PET2-positive patients.

Second cancers occurred at a much higher rate among patients treated with eBEACOPP (14%) compared with patients who continued on ABVD (2%; P =.001).

“Our results emphasize the importance of long-term follow-up of clinical trials in this disease and the need for better biomarkers at diagnosis of HL and less toxic, more active therapies for advanced stage presentations of HL,” the researchers concluded.

Reference

  1. Stephens DM, Li H, Schöder H, et al. Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach for stage III/IV Hodgkin lymphoma [published online July 22, 2019]. Blood. doi:10.1182/blood.2019000719