Gallamini A, et al. - Herein, researchers assessed the impact of a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after 2 doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2), on the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL). The feasibility and efficacy of PET-driven switch from ABVD to escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) were apparent in high-risk patients with advanced-stage HL.

• In consecutively enrolled patients with advanced-stage (IIB to IVB) HL, PET2 was performed after 2 ABVD cycles, and centrally reviewed according to the Deauville five-point scale.
• Random allocation was performed of patients with a positive PET2 to 4 cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by 4 cycles of standard BEACOPP with or without rituximab.
• ABVD was continued in those with a negative PET2.
• Researchers randomly assigned patients with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with a negative PET at the end of chemotherapy to radiotherapy or no further treatment.
• Three-year PFS was the primary end point.

• A total of 782 patients were enrolled, of those, 150 (19%) had a positive and 630 (81%) a negative PET2.
• Data showed that the 3-year PFS of all patients was 82%.
• Researchers found that the 3-year PFS of those with a positive and negative PET2 was 60% and 87%, respectively (P < .001).
• In patients with a positive PET2 assigned to BEACOPP with or without rituximab, the reported 3-year PFS was 63% vs 57% (P=.53).
• Findings demonstrated that in 296 patients with both interim and post-ABVD–negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97% v 93%, respectively; P=.29).
• In addition, the reported 3-year overall survival of all 782 patients was 97% (99% and 89% for PET2 negative and positive, respectively).