PET-CT Scan Can Guide Treatment in Advanced Hodgkin’s Lymphoma Interview with:

Peter Johnson MA, MD, FRCP Professor of Medical Oncology Cancer Research UK Centre Southampton General Hospital Southampton

Prof. Peter Johnson

Peter Johnson MA, MD, FRCP
Professor of Medical Oncology
Cancer Research UK Centre
Southampton General Hospital
Southampton What is the background for this study? What are the main findings?

Prof. Johnson: Based upon retrospective series looking at the ability of interim PET to predict the outcomes of treatment, we aimed to test the idea of modulating treatment in response to an early assessment of the response to ABVD: could we safely reduce the amount of treatment by omitting bleomycin in the group who had responded well? Although the risk of severe toxicity from bleomycin is generally low, for the small number of patients who experience it, it can be life-changing or even fatal. We also wanted to test whether it might be possible to reduce the use of consolidation radiotherapy by comparison to our previous trials, and this seems to have worked too: we used radiotherapy in less than 10% of patients in RATHL, as compared to around half in our previous trials. We have seen better survival figures than in our previous studies with less treatment overall, so it feels as though we are on the right track. What should readers take away from your report?

Prof. Johnson: This study has demonstrated that using an early PET scan is an good way to plan treatment for people with Hodgkin’s lymphoma. We have shown that de-escalating therapy in response to a good response is safe and effective, and by reducing the total amount of treatment being given we hope to see fewer long term side effects. The results are already changing clinical practice, and the overall results are very encouraging: the highest survival rates we have seen in any of our trials to date. What recommendations do you have for future research as a result of this study?

Prof. Johnson: There are still two important areas in which we need to do better:

We would like to optimise the chemotherapy before the PET scan, as more effective treatment seems likely to result in less recurrences in the PET-negative group. Incorporating newer agents such as brentuximab vedotin into the initial therapy might be a way to achieve this without producing too much toxicity.

And secondly we need better treatments for the PET-positive group: again the newer agents such as antibody-drug conjugates or antibodies targeting the PD-1/PDL-1 pathway may be a way to do this. Is there anything else you would like to add?

Prof. Johnson: Overall I think it is important to emphasise that for people under the age of 60, the outlook for Hodgkin’s lymphoma is very good: a lot fewer people died from the lymphoma than from other causes, emphasising the need to minimise toxicity while maximising cures. Thank you for your contribution to the community.


Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma

Peter Johnson, M.D., Massimo Federico, M.D., Amy Kirkwood, M.Sc., Alexander Fosså, M.D., Leanne Berkahn, M.D., Angelo Carella, M.D., Francesco d’Amore, M.D., Gunilla Enblad, M.D., Antonella Franceschetto, M.D., Michael Fulham, M.D., Stefano Luminari, M.D., Michael O’Doherty, M.D., Pip Patrick, Ph.D., Thomas Roberts, B.Sc., Gamal Sidra, M.D., Lindsey Stevens, Paul Smith, M.Sc., Judith Trotman, M.D., Zaid Viney, M.D., John Radford, M.D., and Sally Barrington, M.D.

N Engl J Med 2016; 374:2419-2429

June 23, 2016DOI: 10.1056/NEJMoa1510093

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Last Updated on June 23, 2016 by Marie Benz MD FAAD