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PET response-adapted clinical trials in Hodgkin lymphoma: a comprehensive review

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Abstract

Hodgkin lymphoma (HL) is a highly curable disease, as most HL patients become long-term survivors, with 10-years cure and survival rates after first-line treatment exceeding 80 and 90 %, respectively. Despite these rewarding results, 10–15 % of early stage and 20–25 % of advanced stage patients became chemo-refractory to first-line treatment, and nearly half of them ultimately succumb to their disease. On the other hand, a small but significant fraction of long-term survivors, especially those treated with combined chemoradiation, experience treatment related morbidity and mortality with cardiovascular events and secondary neoplasms arising 5–20 years after the end of therapy. Therefore, an unfulfilled need still exists for a risk-adapted strategy, with a very effective treatment in high-risk patients and a low toxicity regimen in the vast majority of patients who are indeed chemo sensitive. Interim PET scan, performed after few cycles of chemotherapy proved the main predictor of treatment outcome in ABVD-treated patients and superseded the predictive role of traditional prognostic markers. Moreover, simple and reproducible rules for interim PET interpretation agreed among experts have been validated in HL, and are now available for the clinical practice. A number of phase II trials yielded the prof of concept that adapting treatment to interim PET result could ultimately increase long-term disease control in the entire patient population, compared to that obtained with the standard chemotherapy approach. In the present article the results of these pioneer single-centre small trials, as well as the preliminary results of large international prospective trials will be reviewed.

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Prof. A. Gallamini, Anna Borra, Colette Zwarthoed, has no conflicts of interest to disclose.

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  1. Research, Innovation and Statistics Department, A Lacassagne Cancer Centre, 33, Rue de Valombrose, 06189, Nice Cedex 2, France

    A. Gallamini

  2. Haematology Department, S Croce Hospital, Cuneo, Italy

    A. Borra

  3. Nuclear Medicine Department, A Lacassagne Cancer Centre, Nice Cedex 2, France

    C. Zwarthoed

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Gallamini, A., Borra, A. & Zwarthoed, C. PET response-adapted clinical trials in Hodgkin lymphoma: a comprehensive review. Clin Transl Imaging 3, 283–294 (2015). https://doi.org/10.1007/s40336-015-0124-0

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