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The standard of care for patients with newly-diagnosed, advanced-stage, Hodgkin lymphoma (HL), is treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). An alternative first-line regimen is escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP), which has been associated with improved efficacy but also increased toxicity when compared to ABVD.1 Therefore, ABVD treatment is preferred but not all patients are responsive to this regimen. Positron emission tomography (PET) scan can be used to identify patients that are not responsive to ABVD treatment and can be switched to eBEACOPP. After two cycles of ABVD, PET-positive scans seem highly predictive of treatment failure with ABVD.
The phase II Southwest Oncology Group (SWOG) S0816 trial (NCT00822120) investigated the long-term outcomes in patients who received response-adapted therapy based on PET imaging. Patients were treated with two cycles of ABVD and then a PET scan (PET2) was performed to evaluate the efficacy of the treatment. Those achieving a complete response (CR) on PET2 continued with four additional cycles of ABVD, while those who didn’t were switched to eBEACOPP for six cycles.
Results of SWOG S0816 with a median of 3.3 years follow-up have been previously published by Oliver W. Press, Fred Hutchinson Cancer Research Center, Seattle, US and the University of Washington, Seattle, US, and colleagues. The primary endpoints were reached with a two-year progression-free survival (PFS) of 79% for all patients, 82% for PET2-negative patients and 64% for PET2-positive patients. The estimated two-year Overall Survival (OS) was 98%.2 In a paper published in Blood on the 10th of October 2019, Deborah M. Stephens, University of Utah, Salt Lake City, US, and colleagues presented a five-year follow-up of the SWOG S0816 trial.3
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