Dr. Moskowitz on PET-Adapted Therapy in Advanced Hodgkin Lymphoma

Craig Moskowitz, MD, physician-in-chief, Oncology Service Line, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the use of PET-adapted therapy in the treatment of patients with advanced-stage Hodgkin lymphoma.

Patients will have a pre-treatment PET scan to determine the stage of their disease. After 2 cycles of upfront therapy—which in the United States typically consists of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD)—patients will undergo another PET scan. If the results of the PET scan are negative, bleomycin is removed from the regimen, after which patients receive 4 months of AVD. Moskowitz notes that this approach is used in about 80% of patients. The other 20% of patients who have a positive PET scan will receive escalated BEACOPP.

These strategies are based on 2 treatment programs, Moskowitz says. One was the RATHL study, which showed that about 78% of patients who have a negative PET scan at interim re-staging are cured. These are encouraging data but not great, he adds. Researchers now know that if patients with a positive PET scan are continued on the same treatment, only about 40% of patients are cured. Since the majority of patients maintain the therapy they were on, still having 20% to 25% of patients not doing well is unfavorable, says Moskowitz.