US Intergroup Trial of Response-Adapted Therapy for Stage III to IV Hodgkin Lymphoma Using Early Interim Fluorodeoxyglucose–Positron Emission Tomography Imaging: Southwest Oncology Group S0816
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Published:2016-06-10
Issue:17
Volume:34
Page:2020-2027
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ISSN:0732-183X
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Container-title:Journal of Clinical Oncology
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language:en
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Short-container-title:JCO
Author:
Press Oliver W.1, Li Hongli1, Schöder Heiko1, Straus David J.1, Moskowitz Craig H.1, LeBlanc Michael1, Rimsza Lisa M.1, Bartlett Nancy L.1, Evens Andrew M.1, Mittra Erik S.1, LaCasce Ann S.1, Sweetenham John W.1, Barr Paul M.1, Fanale Michelle A.1, Knopp Michael V.1, Noy Ariela1, Hsi Eric D.1, Cook James R.1, Lechowicz Mary Jo1, Gascoyne Randy D.1, Leonard John P.1, Kahl Brad S.1, Cheson Bruce D.1, Fisher Richard I.1, Friedberg Jonathan W.1
Affiliation:
1. Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of...
Abstract
Purpose Four US National Clinical Trials Network components (Southwest Oncology Group, Cancer and Leukemia Group B/Alliance, Eastern Cooperative Oncology Group, and the AIDS Malignancy Consortium) conducted a phase II Intergroup clinical trial that used early interim fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to determine the utility of response-adapted therapy for stage III to IV classic Hodgkin lymphoma. Patients and Methods The Southwest Oncology Group S0816 (Fludeoxyglucose F 18-PET/CT Imaging and Combination Chemotherapy With or Without Additional Chemotherapy and G-CSF in Treating Patients With Stage III or Stage IV Hodgkin Lymphoma) trial enrolled 358 HIV-negative patients between July 1, 2009, and December 2, 2012. A PET scan was performed after two initial cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and was labeled PET2. PET2-negative patients (Deauville score 1 to 3) received an additional four cycles of ABVD, whereas PET2-positive patients (Deauville score 4 to 5) were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for six cycles. Among 336 eligible and evaluable patients, the median age was 32 years (range, 18 to 60 years), with 52% stage III, 48% stage IV, 49% International Prognostic Score 0 to 2, and 51% score 3 to 7. Results Three hundred thirty-six of the enrolled patients were evaluable. Central review of the interim PET2 scan was performed in 331 evaluable patients, with 271 (82%) PET2-negative and 60 (18%) PET2-positive. Of 60 eligible PET2-positive patients, 49 switched to eBEACOPP as planned and 11 declined. With a median follow-up of 39.7 months, the Kaplan-Meier estimate for 2-year overall survival was 98% (95% CI, 95% to 99%), and the 2-year estimate for progression-free survival (PFS) was 79% (95% CI, 74% to 83%). The 2-year estimate for PFS in the subset of patients who were PET2-positive after two cycles of ABVD was 64% (95% CI, 50% to 75%). Both nonhematologic and hematologic toxicities were greater in the eBEACOPP arm than in the continued ABVD arm. Conclusion Response-adapted therapy based on interim PET imaging after two cycles of ABVD seems promising with a 2-year PFS of 64% for PET2-positive patients, which is much higher than the expected 2-year PFS of 15% to 30%.
Publisher
American Society of Clinical Oncology (ASCO)
Subject
Cancer Research,Oncology
Cited by
218 articles.
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