PET Scans to Guide Hodgkin Lymphoma Treatment Improves Remission Rates

Individualized treatment for lymphoma may lead to a new standard of care.

The first large scale trial to test PET imaging as a guide for chemotherapy in Hodgkin lymphoma patients, found it significantly increased the amount of patients who went into remission, while decreasing toxic side effects.

A study published in the Journal of Clinical Oncology focused on patients suffering from Hodgkin lymphoma, a form of cancer with 9,050 cases reported in the United States last year.

“The goal of cancer treatment is to cure as many people as possible with as little toxicity as possible,” said lead study author Oliver Press. “We found a promising way to do that by tailoring treatment to Hodgkin patients, an approach which could lead to a new standard of care.”

Researchers used PET imaging to help treat cancer by testing response-adapted therapy in patients with stage 3 and 4 Hodgkin lymphoma.

During the study, 358 patients were recruited, of whom 331 were able to be evaluated. Hodgkin participants were given 2 rounds of the chemotherapy regimen ABVD, and then were given a PET scan to determine the response to the initial treatment.

If the cancer seemed to have disappeared and the scan was negative, then participants were given the final 4 cycles of ABVD. Patients who had a positive scan were given 6 cycles of the 7-drug chemotherapy regimen called eBEACOPP.

Adverse events for eBEACOPP treatment included infertility, sustained heart or lung damage, and at times there was a greater risk of developing secondary cancers like leukemia.

Approximately 15% to 30% of patients who were cancer-free after 2 years received the typical treatment, which involved 2 rounds of ABVD treatment plus a PET scan and still showed the presence of cancer.

However, the results of the study showed that 64% of patients who switched to eBEACOPP treatment after the PET scan were cancer-free after 2 years, which more than doubled the expected remission rate for this group.

Patients who had a clear scan and were treated solely with ABVD saw even better results, with 82% of participants cancer free and alive after 2 years.

“What's also important is that only 20% of the patients in our trial were exposed to eBEACOPP — which means they weren't exposed to its bad effects,” said researcher Jonathan Friedberg. “That's important because many people diagnosed with Hodgkin lymphoma are in their 20s and 30s and want to have children. This response-adapted therapy would ensure that the people who need the more toxic drugs receive them – and would spare others from infertility and serious toxicities.”