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  • [J Clin Oncol.] US Intergroup Trial of Response-Adapted Therapy for Stage III to IV Hodgkin Lymphoma Using Early Interim Fluorodeoxyglucose-Positron Emission Tomography Imaging: Southwest Oncology Group S0816.

    Fred Hutchinson Cancer Research Center / Oliver W. Press*

  • 출처
    J Clin Oncol.
  • 등재일
    2016 Jun 10
  • 저널이슈번호
    34(17):2020-7. doi: 10.1200/JCO.2015.63.1119. Epub 2016 Apr 11.
  • 내용

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    Abstract

    PURPOSE:

    Four US National Clinical Trials Network components (Southwest Oncology Group, Cancer and Leukemia Group B/Alliance, Eastern Cooperative Oncology Group, and the AIDS Malignancy Consortium) conducted a phase II Intergroup clinical trial that used early interim fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to determine the utility of response-adapted therapy for stage III to IV classic Hodgkin lymphoma.


    PATIENTS AND METHODS:

    The Southwest Oncology Group S0816 (Fludeoxyglucose F 18-PET/CT Imaging and Combination Chemotherapy With or Without Additional Chemotherapy and G-CSF in Treating Patients With Stage III or Stage IV Hodgkin Lymphoma) trial enrolled 358 HIV-negative patients between July 1, 2009, and December 2, 2012. A PET scan was performed after two initial cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and was labeled PET2. PET2-negative patients (Deauville score 1 to 3) received an additional four cycles of ABVD, whereas PET2-positive patients (Deauville score 4 to 5) were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for six cycles. Among 336 eligible and evaluable patients, the median age was 32 years (range, 18 to 60 years), with 52% stage III, 48% stage IV, 49% International Prognostic Score 0 to 2, and 51% score 3 to 7.

     

    RESULTS:

    Three hundred thirty-six of the enrolled patients were evaluable. Central review of the interim PET2 scan was performed in 331 evaluable patients, with 271 (82%) PET2-negative and 60 (18%) PET2-positive. Of 60 eligible PET2-positive patients, 49 switched to eBEACOPP as planned and 11 declined. With a median follow-up of 39.7 months, the Kaplan-Meier estimate for 2-year overall survival was 98% (95% CI, 95% to 99%), and the 2-year estimate for progression-free survival (PFS) was 79% (95% CI, 74% to 83%). The 2-year estimate for PFS in the subset of patients who were PET2-positive after two cycles of ABVD was 64% (95% CI, 50% to 75%). Both nonhematologic and hematologic toxicities were greater in the eBEACOPP arm than in the continued ABVD arm.

     

    CONCLUSION:

    Response-adapted therapy based on interim PET imaging after two cycles of ABVD seems promising with a 2-year PFS of 64% for PET2-positive patients, which is much higher than the expected 2-year PFS of 15% to 30%. 

     

    Author information

    Press OW1, Li H2, Schöder H2, Straus DJ2, Moskowitz CH2, LeBlanc M2, Rimsza LM2, Bartlett NL2, Evens AM2, Mittra ES2, LaCasce AS2, Sweetenham JW2, Barr PM2, Fanale MA2, Knopp MV2, Noy A2, Hsi ED2, Cook JR2, Lechowicz MJ2, Gascoyne ​RD2, Leonard JP2, Kahl BS2, Cheson BD2, Fisher RI2, Friedberg JW2.

    1Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA. press@u.washington.edu.

    2Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA. 

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