The New England Journal of Medicine recently published results from a study where researchers used positron-emission tomography-computed tomography (PET-CT) scans to guide treatment for patients with advanced Hodgkin lymphoma. The chemotherapy used to treat Hodgkin lymphoma can be associated with long-term health risks including toxicity in the lungs as a result of the chemotherapy agent bleomycin. Decreasing the risk of long-term toxicity is especially important in Hodgkin lymphoma where the majority of patients will be cured of their disease and their long term quality of life heavily factors into treatment decisions.
In this study patients were treated with 2 cycles of the chemotherapy regimen ABVD, which includes bleomycin. After 2 cycles of ABVD patients underwent a PET-CT scan. Patients who had a positive PET scan received more intensive therapy with the BEACOPP chemotherapy regimen. Patients who had a negative PET-CT were randomly assigned to continue treatment with ABVD or receive AVD, which does not include bleomycin. The outcomes of the ABVD and AVD groups were compared.
A total of 1,214 patients enrolled in this trial and the majority (83.7%) had a negative PET-CT after two cycles of ABVD. The statistical analysis comparing the group receiving ABVD with the group receiving AVD was designed to determine if AVD was not inferior to ABVD non-inferiority. Although the data fell just short of demonstrating non-inferiority, the difference in outcome between the AVD and ABVD groups was minimal (1.6%). Importantly, the risk of lung toxicity was higher in the group of patients who continued to receive ABVD.
This data suggests that omitting bleomycin in the treatment of patients with advanced Hodgkin lymphoma, who have a negative PET-CT after 2 cycles of ABVD, decreases the risk of lung toxicity without significantly increasing the risk of relapse.