Top

Published in:

01-10-2012 | Lymphomas (PA Hamlin, Section Editor)

PET/CT Adapted Therapy in Hodgkin Disease: Current State of the Art and Future Directions

Author: Eldad J. Dann

Published in: Current Oncology Reports | Issue 5/2012

Abstract

Current therapy of Hodgkin disease (HD) is based on risk assessment, taking into consideration both staging and risk factors. Interim positron emission tomography/computerized tomography (PET/CT) has proven to distinguish between patients with advanced disease who have early response and good prognosis and those with interim positive response who have inferior progression free survival (PFS) with current therapy. Several issues need to be elucidated: (1) Which interim study should be defined as positive? (2) Should the same cutoff value be used for decision-making about escalation vs de-escalation of therapy? (3) Should it apply to different chemotherapy protocols? Currently, there are several ongoing studies where treatment is modified based on interim PET/CT. These studies may enable the medical community to establish whether bleomycin or radiation therapy could be omitted in early responders, whether chemotherapy could be shortened in these patients, and whether therapy escalation for patients with interim positive PET/CT could decrease disease progression rate.

Hutchings M, Mikhaeel NG, Fields PA, Nunan T, Timothy AR. Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol. 2005;16:1160–8.PubMedCrossRef

Gallamini A, Hutchings M, Rigacci L, Specht L, Merli F, Hansen M, et al. Early interim 2- [18 F] fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian-Danish study. J Clin Oncol. 2007;25:3746–52.PubMedCrossRef

Juweid ME, Stroobants S, Hoekstra OS, Mottaghy FM, Dietlein M, Guermazi A, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. 2007;25:571–8.PubMedCrossRef

Gallamini A, Fiore F, Sorasio R, Meignan M. Interim positron emission tomography scan in Hodgkin lymphoma: definitions, interpretation rules, and clinical validation. Leuk Lymphoma. 2009;50:1761–4.PubMedCrossRef

Dann EJ, Bar-Shalom R, Tamir A, Epelbaum R, Avivi I, Ben-Shachar M, et al. A functional dynamic scoring model to elucidate the significance of post-induction interim fluorine-18-fluorodeoxyglucose positron emission tomography findings in patients with Hodgkin's lymphoma. Haematologica. 2010;95:1198–206.PubMedCrossRef

Gallamini A. International Validation Study of the Prognostic Role of Interim-PET Scan in ABVD-treated, Advanced Stage Hodgkin Lymphoma. 3rd International Workshop on Interim PET in Lymphoma, Menton (France), September 26–27,2011. Available at: http://eitti.free.fr. Accessed April 2012.

Avigdor A, Bulvik S, Levi I, Dann EJ, Shemtov N, Perez-Avraham G, et al. Two cycles of escalated BEACOPP followed by four4 cycles of ABVD utilizing early-interim PET/CT scan is an effective regimen for advanced high-risk Hodgkin's lymphoma. Ann Oncol. 2010;21:126–32.PubMedCrossRef

•• Gallamini A, Patti C, Viviani S, Rossi A, Fiore F, Di Raimondo F, et al. Early chemotherapy intensification with BEACOPP in advanced-stage Hodgkin lymphoma patients with a interim-PET positive after 2 ABVD courses. Br J Haematol. 2011;152:551–60. This work demonstrates that augmentation of therapy following positive interim PET may improve progression-free survival..PubMedCrossRef

Hutchings M, Loft A, Hansen M, Pedersen LM, Buhl T, Jurlander J, et al. FDG-PET after 2 cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood. 2006;107:52–9.PubMedCrossRef

10.

Barnes JA, LaCasce AS, Zukotynski K, Israel D, Feng Y, Neuberg D, et al. End-of-treatment but not interim PET scan predicts outcome in nonbulky limited-stage Hodgkin's lymphoma. Ann Oncol. 2011;22:910–5.PubMedCrossRef

11.

Sher DJ, Mauch PM, Van Den Abbeele A, LaCasce AS, Czerminski J, Ng AK. Prognostic significance of mid- and post-ABVD PET imaging in Hodgkin's lymphoma: the importance of involved-field radiotherapy. Ann Oncol. 2009;20:1848–53.PubMedCrossRef

12.

Barrington SF, Mackewn JE, Schleyer P, Marsden PK, Mikhaeel NG, Qian W, et al. Establishment of a UK-wide network to facilitate the acquisition of quality assured FDG-PET data for clinical trials in lymphoma. Ann Oncol. 2011;22:739–45.PubMedCrossRef

13.

Meignan M, Itti E, Bardet S, Lumbroso J, Edeline V, Olivier P, et al. Development and application of a real-time on-line blinded independent central review of interim PET scans to determine treatment allocation in lymphoma trials. J Clin Oncol. 2009;27:2739–41.PubMedCrossRef

14.

HD17 for Intermediate Stages–Treatment Optimization Trial in the First-Line Treatment of Intermediate Stage Hodgkin Lymphoma. Available at: http://clinicaltrials.gov/ct2/show/NCT01356680. Accessed April 2012.

15.

HD18 for Advanced Stages in Hodgkins Lymphoma. Available at: http://clinicaltrials.gov/ct2/show/NCT00515554. Accessed April 2012.

16.

•• Kasamon YL. Prognostication and risk-adapted therapy of Hodgkin's lymphoma using positron emission tomography. Adv Hematol. 2011;2011:271595. This review presents important data regarding the latest studies using interim PET, including PPV, NPV and rate of positive PET results in various patient cohorts .

17.

Pavlovsky A, Fernandez I, Prates V, Pavlovsky MA, Zoppegno L, Basquiera AL, et al. PET -CT Adapted Therapy After 3 Cycles of ABVD for All Stages of Hodgkin Lymphoma. Preliminary Results in 193 Patients. Blood. 2011;118:1619a.

18.

Straus DJ, Johnson JL, LaCasce AS, Bartlett NL, Kostakoglu L, Hsi ED, et al. Doxorubicin, vinblastine, and gemcitabine (CALGB 50203) for stage I/II nonbulky Hodgkin lymphoma: pretreatment prognostic factors and interim PET. Blood. 2011;117:5314–20.PubMedCrossRef

19.

Dann EJ, Bar-Shalom R, Tamir A, Haim N, Ben-Shachar M, Avivi I, et al. Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome. Blood. 2007;109:905–9.PubMedCrossRef

20.

•• Dann EJ, Blumenfeld Z, Bar-Shalom R, Avivi I, Ben-Shachar M, Goor O, et al. A 10-year experience with treatment of high and standard risk Hodgkin disease: six6 cycles of tailored BEACOPP, with interim scintigraphy, are effective and female fertility is preserved. Am J Hematol. 2012;87:32–6. This prospective study was the first to use interim PET for tailoring therapy in patients with Hodgkin disease and currently, the 10-year follow-up data, including fertility status, are provided..PubMedCrossRef

21.

Phase 2 Study–Tailored Therapy for Hodgkin Lymphoma Based on Predefined Risk Factors and Early Interim PET/CT for Response Assessment and Further Therapy Decisions. Available at: http://clinicaltrials.gov/ct2/show/NCT00392314. Accessed April 2012.

22.

Phase II Trial of Response–Adapted Chemotherapy Based on Positron Emission Tomography for Non-Bulky Stage I and II Hodgkin Lymphoma. Available at: http://clinicaltrials.gov/ct2/show/NCT01132807. Accessed April 2012.

23.

Phase II Trial of Response–Adapted Therapy Based on Positron Emission Tomography (PET) for Bulky Stage I and Stage II Classical Hodgkin Lymphoma (HL). Available at: http://clinicaltrials.gov/ct2/show/NCT01118026. Accessed April 2012.

24.

HD16 for Early Stages–Treatment Optimization Trial in the First-line Treatment of Early Stage Hodgkin Lymphoma; Treatment Stratification by Means of FDG-PET. Available at: http://clinicaltrials.gov/ct2/show/NCT00736320. Accessed April 2012.

25.

The H10 EORTC/GELA/IIL Randomized Intergroup Trial on Early FDG-PET Scan Guided Treatment Adaptation Versus Standard Combined Modality Treatment in Patients With Supradiaphragmatic Stage I/II Hodgkin's Lymphoma. Available at: http://clinicaltrials.gov/ct2/show/NCT00433433. Accessed April 2012

26.

A Randomised Phase III Trial to Determine the Role of FDG-PET Imaging in Clinical Stages IA/IIA Hodgkin's Disease. Available at: http://clinicaltrials.gov/ct2/show/NCT00943423. Accessed April 2012

27.

A Phase II Trial of Response–Adapted Therapy of Stage III-IV Hodgkin Lymphoma Using Early Interim FDG-PET Imaging. Available at: http://clinicaltrials.gov/ct2/show/NCT00822120. Accessed April 2012

28.

Multicenter Clinical Study With Early Treatment Intensification In Patients With High- Risk Hodgkin Lymphoma, Identified As FDG-PET Scan Positive After 2 Conventional ABVD Courses. Available at: http://clinicaltrials.gov/ct2/show/NCT00795613. Accessed April 2012

Title: PET/CT Adapted Therapy in Hodgkin Disease: Current State of the Art and Future Directions
Author: Eldad J. Dann
Publication date: 01-10-2012
Publisher: Current Science Inc.
Published in: Current Oncology Reports / Issue 5/2012
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI: https://doi.org/10.1007/s11912-012-0250-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2012

Transformation in Follicular Lymphoma: Biology, Prognosis, and Therapeutic Options

Acute Myeloid Leukemia with Normal Cytogenetics

Novel Agents in Hodgkin Lymphoma

B-Cell Receptor Pathobiology and Targeting in NHL

Philadelphia-Positive Acute Lymphoblastic Leukemia: Current Treatment Options

Screening and Prevention Measures for Melanoma: Is There a Survival Advantage?

Keynote webinar | Spotlight on antibody–drug conjugates in cancer