PET project.

Top Line: PET-adaptive treatment for early stage Hodgkin lymphoma (HL) seems to have panned out pretty well, so what about more advanced stages?
The Study: Final results of HD 0607 are out this week in JCO and it's packed with data. 782 patients with stage IIB-IVB HL received ABVD x 2 then restaging PET. If PET-negative (81%), they went on to complete a total of ABVD x 6 +/- consolidative radiation to nodes initially > 5 cm. If PET-positive (19%), they received eBEACOPP x 4 then standard BEACOPP x 4 +/- rituximab. The 3-year progression-free survival (PFS) rate for PET-negative patients was an impressive 87% (radiation made no difference) and for PET-positive patients was 60% (rituximab made no difference). Why this design? Escalated BEACOPP is some serious chemo that both improves survival and multiplies the toxicity--so selecting the patients who will benefit most (like with, say, a PET) maintains promising cure rates while minimizing toxicity.
The Bottom Line: Employing a PET-adaptive strategy in advanced stage HL allows for up to 80% of patients to achieve excellent disease control with (way) less intensive chemo.


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