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.
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.
- 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