Using PET imaging to guide chemotherapy increases the chances of remission and reduces side effects in patients with advanced Hodgkin lymphoma, a SWOG trial reports.

The phase II SWOG S0816 study involved 331 patients with Stage III and IV Hodgkin lymphoma who received a PET scan after two initial cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).

Patients who had a negative scan (Deauville score 1 to 3) received an additional four cycles of ABVD, whereas those with a positive scan (Deauville score 4 to 5) were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for six cycles.

The two-year estimate for PFS in the subset of patients who had positive scans after two cycles of ABVD was 64% (95% CI, 50% to 75%), a finding which the authors noted was much higher than the expected survival rate of between 15 to 30 percent.

In the patients with a negative scan who were treated exclusively with ABVD treatment the two-year PFS rate was 82 percent.

According to lead author Dr. Oliver Press from the Fred Hutchinson Cancer Research Center said the goal of cancer treatment was to cure as many people as possible with as little toxicity as possible.

“We found a promising way to do that by tailoring treatment to Hodgkin patients, an approach which could lead to a new standard of care,” he said.

Writing in an accompanying editorial Peter Borchmann and Andreas Engert, from the University Hospital of Cologne, in Germany said the trial results would create new opportunities for risk-adapted treatment of patients with advanced-stage HL.

However, questions remained such as the lack of a control group for PET-positive patients after initial treatment with ABVD.

The relevant PFS improvement observed also raised the question of whether BEACOPP-e would be better if used instead of ABVD for first-line therapy to improve PFS for all patients, where treatment intensity could be decreased for PET-negative responders.

They noted that one of the major arguments against a broader use of BEACOPP-e was toxicity; however, the balance between risk and benefit of treatment depends on individual priorities, which were not usually addressed in clinical trials.