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Adapted Treatment G...
Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin's Lymphoma
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- Johnson, Peter (author)
- Univ Southampton, Canc Res UK Ctr, Southampton SO16 6YD, Hants, England.
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- Federico, Massimo (author)
- Univ Modena & Reggio Emilia, Dept Diagnost Clin & Publ Hlth Med, Modena, Italy.
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- Kirkwood, Amy (author)
- Canc Res UK, London, England.;UCL, Canc Trials Ctr, London, England.
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- Fossa, Alexander (author)
- Oslo Univ Hosp, Dept Med Oncol, Oslo, Norway.
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- Berkahn, Leanne (author)
- Auckland City Hosp, Dept Haematol, Auckland, New Zealand.
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- Carella, Angelo (author)
- San Martino Univ Hosp, Dept Hematol, Genoa, Italy.
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- d'Amore, Francesco (author)
- Aarhus Univ Hosp, Dept Hematol, DK-8000 Aarhus, Denmark.
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- Enblad, Gunilla (author)
- Uppsala universitet,Experimentell och klinisk onkologi
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- Franceschetto, Antonella (author)
- Univ Modena & Reggio Emilia, Dept Diagnost Clin & Publ Hlth Med, Modena, Italy.
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- Fulham, Michael (author)
- Royal Prince Alfred Hosp, Dept Mol Imaging, Sydney, NSW, Australia.
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- Luminari, Stefano (author)
- Univ Modena & Reggio Emilia, Dept Diagnost Clin & Publ Hlth Med, Modena, Italy.;IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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- O'Doherty, Michael (author)
- Kings Coll London, Kings Hlth Partners, St Thomas Hosp, PET Imaging Ctr, London WC2R 2LS, England.
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- Patrick, Pip (author)
- Canc Res UK, London, England.;UCL, Canc Trials Ctr, London, England.
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- Roberts, Thomas (author)
- Canc Res UK, London, England.;UCL, Canc Trials Ctr, London, England.
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- Sidra, Gamal (author)
- Lincoln Cty Hosp, Dept Haematol, Lincoln, England.
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- Stevens, Lindsey (author)
- Canc Res UK, London, England.;UCL, Canc Trials Ctr, London, England.
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- Smith, Paul (author)
- Canc Res UK, London, England.;UCL, Canc Trials Ctr, London, England.
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- Trotman, Judith (author)
- Univ Sydney, Concord Repatriat Gen Hosp, Sydney, NSW 2006, Australia.
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- Viney, Zaid (author)
- Kings Coll London, Kings Hlth Partners, St Thomas Hosp, PET Imaging Ctr, London WC2R 2LS, England.
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- Radford, John (author)
- Christie Hosp, Dept Med Oncol, Manchester, Lancs, England.
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- Barrington, Sally (author)
- Kings Coll London, Kings Hlth Partners, St Thomas Hosp, PET Imaging Ctr, London WC2R 2LS, England.
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Univ Southampton, Canc Res UK Ctr, Southampton SO16 6YD, Hants, England Univ Modena & Reggio Emilia, Dept Diagnost Clin & Publ Hlth Med, Modena, Italy. (creator_code:org_t)
- 2016
- 2016
- English.
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In: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 374:25, s. 2419-2429
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- BACKGROUND We tested interim positron-emission tomography-computed tomography (PET-CT) as a measure of early response to chemotherapy in order to guide treatment for patients with advanced Hodgkin's lymphoma. METHODS Patients with newly diagnosed advanced classic Hodgkin's lymphoma underwent a baseline PET-CT scan, received two cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy, and then underwent an interim PET-CT scan. Images were centrally reviewed with the use of a 5-point scale for PET findings. Patients with negative PET findings after two cycles were randomly assigned to continue ABVD (ABVD group) or omit bleomycin (AVD group) in cycles 3 through 6. Those with positive PET findings after two cycles received BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). Radiotherapy was not recommended for patients with negative findings on interim scans. The primary outcome was the difference in the 3-year progression-free survival rate between randomized groups, a noninferiority comparison to exclude a difference of 5 or more percentage points. RESULTS A total of 1214 patients were registered; 937 of the 1119 patients (83.7%) who underwent an interim PET-CT scan according to protocol had negative findings. With a median follow-up of 41 months, the 3-year progression-free survival rate and overall survival rate in the ABVD group were 85.7% (95% confidence interval [CI], 82.1 to 88.6) and 97.2% (95% CI, 95.1 to 98.4), respectively; the corresponding rates in the AVD group were 84.4% (95% CI, 80.7 to 87.5) and 97.6% (95% CI, 95.6 to 98.7). The absolute difference in the 3-year progression-free survival rate (ABVD minus AVD) was 1.6 percentage points (95% CI, -3.2 to 5.3). Respiratory adverse events were more severe in the ABVD group than in the AVD group. BEACOPP was given to the 172 patients with positive findings on the interim scan, and 74.4% had negative findings on a third PET-CT scan; the 3-year progression-free survival rate was 67.5% and the overall survival rate 87.8%. A total of 62 patients died during the trial (24 from Hodgkin's lymphoma), for a 3-year progression-free survival rate of 82.6% and an overall survival rate of 95.8%. CONCLUSIONS Although the results fall just short of the specified noninferiority margin, the omission of bleomycin from the ABVD regimen after negative findings on interim PET resulted in a lower incidence of pulmonary toxic effects than with continued ABVD but not significantly lower efficacy.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)
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- ref (subject category)
- art (subject category)
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Johnson, Peter
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Federico, Massim ...
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Kirkwood, Amy
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Fossa, Alexander
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Berkahn, Leanne
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Carella, Angelo
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d'Amore, Frances ...
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Enblad, Gunilla
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Franceschetto, A ...
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Fulham, Michael
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Luminari, Stefan ...
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O'Doherty, Micha ...
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Patrick, Pip
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Roberts, Thomas
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Sidra, Gamal
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Stevens, Lindsey
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Smith, Paul
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Trotman, Judith
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Viney, Zaid
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Radford, John
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Barrington, Sall ...
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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New England Jour ...
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Uppsala University