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Clinical Trial
. 2019 Oct 10;134(15):1238-1246.
doi: 10.1182/blood.2019000719.

Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma

Deborah M Stephens  1 , Hongli Li  2 , Heiko Schöder  3 , David J Straus  3 , Craig H Moskowitz  3 , Michael LeBlanc  2 , Lisa M Rimsza  4 , Nancy L Bartlett  5 , Andrew M Evens  6 , Ann S LaCasce  7 , Paul M Barr  8 , Michael V Knopp  9 , Eric D Hsi  10 , John P Leonard  11 , Brad S Kahl  5 , Sonali M Smith  12 , Jonathan W Friedberg  8
Affiliations
Clinical Trial

Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma

Deborah M Stephens et al. Blood. .

Abstract

Patients with advanced-stage Hodgkin lymphoma (HL) demonstrated excellent 2-year progression-free survival (PFS) after receiving positron emission tomography (PET)-adapted therapy on SWOG S0816. Patients received 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Patients achieving complete response (CR) on PET scan following cycle 2 of ABVD (PET2) continued 4 additional cycles of ABVD. Patients not achieving CR on PET2 were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for 6 cycles. After a median follow-up of 5.9 years, a subset of 331 eligible patients with central review of PET2 was analyzed. PET2 was negative in 82% and positive in 18%. For all patients, the estimated 5-year PFS and OS was 74% (95% confidence interval [CI], 69%-79%) and 94% (95% CI, 91%-96%), respectively. For PET2- and PET2+ patients, the 5-year PFS was 76% (95% CI, 70%-81%) and 66% (95% CI, 52%-76%), respectively. Seven (14%) and 6 (2%) patients reported second cancers after treatment with eBEACOPP and ABVD, respectively (P = .001). Long-term OS of HL patients treated on S0816 remains high. Nearly 25% of PET2- patients experienced relapse events, demonstrating limitations ABVD therapy and of the negative predictive value of PET2. In PET2+ patients who received eBEACOPP, PFS was favorable, but was associated with a high rate of second malignancies compared with historical controls. Our results emphasize the importance of long-term follow-up, and the need for more efficacious and less toxic therapeutic approaches for advanced-stage HL patients. This trial was registered at www.clinicaltrials.gov as #NCT00822120.

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Conflict of interest statement

Conflict-of-interest disclosure: D.M.S. has received research funding from Acerta, Gilead, Karyopharm and honoraria from Genentech. H.S. has served as a consultant for Allero Therapeutics. D.J.S. has received research funding from and serves as a consultant for Seattle Genetics. L.M.R. holds a patent through NanoString. N.L.B. has received research funding from Gilead, Kite, Seattle Genetics, Affimed, Bristol-Myers Squibb, Celgene, Forty Seven, Genentech, Immune Design, Janssen, Merck, Millennium, and Pharmacyclics, and serves as a consultant for Pfizer and Acerta. A.M.E. serves as a consultant for and has received honoraria from Seattle Genetics, Bayer, Verastem, and Pharmacyclics. A.S.L. serves as a consultant for Seattle Genetics and Bristol-Myers Squibb. P.M.B. serves as a consultant for AbbVie. E.D.H. serves as a consultant for Celgene, Seattle Genetics, and Jazz and has received research funding from AbbVie and Eli Lilly. J.P.L. serves as a consultant for Celgene, Juno, Bristol-Myers Squibb, Sutro, Gilead, Genentech, Pfizer, Bayer, Biotest, United Therapeutics, Karyopharm, ADC Therapeutics, MEI Pharma, AstraZeneca, and Novartis. B.S.K. serves as a consultant for Genentech, Celgene, Acerta, AstraZeneca, Juno, CTI, ADC Therapeutics, AbbVie, Gilead, and Seattle Genetics. S.M.S. serves as a consultant for Bristol-Myers Squibb, Humanigen, and Seattle Genetics and has received research funding from Forty Seven and Sanofi. J.W.F. has received honoraria from Bayer. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flowchart for analyzed HL patients treated on protocol S0816.
Figure 2.
Figure 2.
Survival of 336 HIV−patients on SWOG S0816. PFS (A) and OS (B). Conf. Int., confidence interval.
Figure 3.
Figure 3.
PFS and OS of 331 HIV−patients treated on SWOG S0816. (A) PFS for patients with PET2+; (B) PFS for patients with PET2−; (C) OS for patients with PET2+; and (D) OS for patients with PET2−.
See this image and copyright information in PMC

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References

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