EHA 2020 – PET-guided treatment may allow many patients with Hodgkin lymphoma to avoid radiotherapy


  • Ben Gallarda
  • Univadis
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Takeaway

  • Standard of care radiotherapy (RT) was omitted in patients with early-stage unfavorable Hodgkin lymphoma (HL) responsive to chemotherapy (CT) without loss of treatment efficacy.
  • Positron emission tomography (PET) assessment of CT response in these patients guided the decision to omit RT.

Why this matters

  • Routine use of RT puts these typically younger patients at a risk for long-term side effects, including an increased risk for secondary cancers.

Study design

  • Phase 3 international randomized controlled prospective trial of 1100 patients aged 18-60 years with newly diagnosed unfavorable HL.
  • Patients were assigned to combined modality treatment (CMT): 4 cycles of CT followed by 30 Gy involved-field RT or PET-guided treatment, which omitted RT in patients with Deauville score (DS)
  • Funding: Deutsche Krebshilfe, German Cancer Aid.

Key results

  • 979 patients had confirmed PET results: 66.5% were PET-negative, 24.3% had DS3, and 9.2% DS4.
  • Overall 5-year progression-free survival (PFS):
    • CMT group (n=428): 97.3%.
    • PET-guided treatment (n=477): 95.1%.
    • Difference: −2.2% (95% CI, −5.3% to 0.9%), excluding prespecified lower noninferiority margin of −8%.
  • 5-year PFS in PET-negative patients:
    • CMT group, with RT: 97.7%.
    • PET-guided group, no RT: 95.9%.
  • PET-positivity was confirmed as a significant risk factor for disease progression.

Limitations

  • Low number of fatal events.

Outlook

  • Dr Borchmann, who presented these findings commented that “PET-guided 2+2 chemotherapy is the new GHSG [German Hodgkin Study Group] standard of care,” and that “Most patients with this disease will not need radiotherapy any longer.”