NEW YORK (Reuters Health) - Positron emission tomography (PET) after one cycle of chemotherapy has a high prognostic accuracy in Hodgkin lymphoma and may help select patients for less-intensive treatment, researchers have found.
A negative (18F)fluorodeoxyglucose (FDG)-PET scan after two or three chemotherapy cycles is already known to be associated with a favorable diagnosis, they write in the Journal of Clinical Oncology, online July 16.
"The two main advantages of assessing treatment sensitivity earlier rather than later are a better negative predictive value, meaning that treatment de-escalation to treatment-sensitive patients can be done with less risk of failure, and a better chance that escalation/treatment change in poor-responding patients can be performed before development of treatment resistance (more hypothetical)," Dr. Martin Hutchings, an oncologist at Copenhagen University Hospital in Denmark and lead author of the study, told Reuters Health by email.
Dr. Hutchings and colleagues conducted a prospective study of patients newly diagnosed with Hodgkin lymphoma who were being treated at lymphoma centers in the U.S., Italy, Poland and Denmark.
Patients with early-stage and advanced-stage disease were included in the study and treatment was not modified based on the results of early interim FDG-PET/CT scans.
All patients had a PET scan within the last five days of their first chemotherapy cycle (PET1). Patients in the U.S. and Italy had a PET scan after the second cycle of chemotherapy (PET2) only if the first scan was positive, whereas all patients in Poland and Denmark had a second PET scan. Two independent, blinded reviewers evaluated all the PET scans using the Deauville five-point scale.
A total of 126 patients were included in the study and 89 (70.6%) had a negative scan after the first cycle of chemotherapy. Two-year progression-free survival was 94.1% for patients with a negative PET1 scan and 40.8% for those with a positive PET1 scan.
For those with both PET1 and PET2 scans, two-year progression-free survival was 98.3% for PET1-negative patients and 38.5% PET1 positive patients. For PET2-negative and -positive patients it was 90.2% and 23.1%, respectively.
No patients with a negative PET1 scan subsequently had a positive PET2 scan.
"This study has convincingly demonstrated the promise of early interim PET in Hodgkin lymphoma, not only as a prognostic tool, but as a tool to assess treatment sensitivity early enough to potentially allow tailoring of the treatment to the individual patient," said Dr. Hutchings.
SOURCE: http://bit.ly/1o6LWlr
J Clin Oncol 2014.
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