PET-adapted treatment improves outcomes for patients with stage I/II Hodgkin lymphoma

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LUGANO, SWITZERLAND—Early FDG-PET (2-deoxy-2[F-18]fluoro-D-glucose positron emission tomography) adapted treatment improves the outcome of early FDG-PET-positive patients with stages I/II Hodgkin lymphoma. These final results from the randomized intergroup EORTC, LYSA (Lymphoma Study Association), FIL (Fondazione Italiana Linfomi) H10 trial were presented at the 13th International Conference on Malignant Lymphoma (13-ICML).

"Even though the prognosis for patients with stage I/II HL is excellent if they are treated with the standard regimen of chemotherapy combined with radiotherapy, tumor control could still be improved for specific subgroups of patients, and late toxicity could be reduced for others,” said John Raemaekers, MD, PhD, of the Radboud University Medical Center Nijmegen and the Rijnstate Hospital Arnhem, The Netherlands, and EORTC principal study coordinator on behalf of the EORTC/LYSA/FIL Intergroup H10 team.

“This trial, therefore, addressed two questions. First, can the outcome for early FDG-PET-positive patients with stages I/II Hodgkin lymphoma be improved by administering early intensification of chemotherapy? Second, can involved-node radiotherapy be omitted from the standard combined modality treatment in early PET-negative patients?"

This intergroup trial demonstrated that patients with stage I/II Hodgkin Lymphoma, who are still FDG-PET positive after two cycles of ABVD chemotherapy, significantly benefit in terms of progression-free survival from intensification to BEACOPPesc chemotherapy followed by involved-node radiotherapy compared to patients who continue standard ABVD chemotherapy followed by involved-node radiotherapy (5-year progression-free survival rates 91% versus 77%, HR=0.42, 95% CI:0.23 to 0.74, P=.002, with a difference of 13%, 95% CI:5% to 21%).

The analysis of the early PET negative group confirmed the conclusions of the previously published interim analysis. The study could not demonstrate that treatment with chemotherapy only is noninferior to the standard combined modality treatment in terms of progression free survival.

The Intergroup EORTC/LYSA/FIL H10 20051 trial included 1,950 patients age 15 to 70 years with previously untreated stage I/II supradiaphragmatic, classical Hodgkin Lymphoma. This trial was conducted at 158 sites located in eight countries: France, Italy, The Netherlands, Belgium, Denmark, Croatia, Slovakia, and Switzerland.

Support for this trial came from Fondation belge contre le Cancer (Belgium); Dutch Cancer Society (the Netherlands); Institut National du Cancer, Fondation Contre le Cancer, Assistance Publique Hôpitaux Paris, and Société Française de Medecine Nucleaire et Imagerie Moleculaire (France); Associazone Angela Serra (Italy); and Chugai Pharmaceutical (Japan).

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