Page 35 - 18F-FDG PET as biomarker in aggressive lymphoma; technical and clinical validation

Interim PET as biomarker of response in HL and DLBCL?
2-yr TTTF: 79% i-PET+/47% PET 4: 2-yr PFS 81%/73% PET 2: 2-yr PFS 73%/77% 4-yr OS: 96%/73% sign 2-yr OS 93%/ 84% NS 4-yr PFS: 91%/59% 2-yr OS 94%/83% NS 3-yr EFS: 82%/65% 2-yr EFS 89%/75% i-PET- sign. PFS NS OS NS NS NS sign Median 33.6 mo FUP 33 mo 45 mo 19 mo 44 mo i-PET positive 4x R-ICE (+RT if end of treatment 3x ICE; biopsy 1x R-ICE+ASCT 2x (R-)ESHAP Z-BEAM ASCT 6x R-CHOP or or 2x R-ICE PET pos) 6x ‘Burkitt biopsy neg: MTXiv + protocol’ therapy pos:2x ICE+ MTX+ R-ifos- i-PET negative
4x R-CHOP+2R R-CHOP14 or
2x R-CHOP21
4x R-CHOP or VP-16 +AraC (R-)CHOP14 therapy
3x ICE
HL: Hodgkin lymphoma; DLBCL: diffuse large B-cell lymphoma; PMBCL: primary mediastinal large B-cell lymphoma; NHL: non-Hodgkin lymphoma; iPET; interim cytarabine, methylprednisone; FUP: follow-up; mo: months; yr: years; PFS: progression free survival; i-t-t: intention-to-treat; p-p A: per-protocol analysis; fav.=favorable; or 21
radiotherapy; NFT: no further treatment; INRT: involved node radiotherapy; AVD: doxorubicin, vinblastine and dacarbazine; 2R: 2 cycles rituximab; MTX: methotrexate; ASCT: autologous stem cell transplantation; R-DICEP: rituximab, dose intensive cyclophosphamide, etoposide, cisplatin; R-IFE: rituximab, ifosfamide, etoposide; MTXiv: intravenous methotrexate; Z-BEAM: ibritumomab tiuxetan, carmustine, etoposide, cytarabine, melphalan; R-ESHAP: rituximab, etoposide, cisplatin, high-dose unfav=unfavorable; OS: overall survival; EFS: event-free survival; TTTF: time to treatment failure; NS: not significant; Sign: statistically significant; ECOG; Eastern positron emission tomography; RCT: randomized clinical trial; phase II: prospective phase II study; st: stage; adv: advanced; gr: grade; ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine; (R-)CHOP: (rituximab,) cyclophosphamide, doxorubicin, vincristine, prednisone; R-ACVBP: rituximab, doxorubicin, vindesine, bleomycin, prednisone; DS: Deauville score; IHP: international harmonization project; SUV: standardized uptake value; bg: background; rand: randomization; IF RT: involved field R-ifos-VP-16: rituximab, ifosfamide, vindesine; AraC: cytosine arabinoside; RT: radiotherapy; (R-)ICE: (rituximab,) ifosfamide, carboplatin, etoposide; BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone; esc: escalated; BEAM: carmustine, etoposide, cytarabine, melphalan; reduction
>local bg
criteria
> bg
∆SUV
Pos
<66%
IHP
IHP
2x R-CHOP
R-CHOP14
R-CHOP21
R-ACVBP
R-CHOP14
(R-)CHOP
2 or 3X
2x
4x
or
2x
4x
102
150
853
59
98
NHL (~80%
aggressive
DLBCL)
aggressive
adv stage
PMBCL
adv stage
PMBCL
DLBCL/
DLBCL
DLBCL/
B-cell
lymphoma
phase
phase
pective
phase
Pros-
RCT
II
II
II
Cooperative Oncology Group.
16
14
Table 1. Continued
19
Moskowitz 2010
27
Dührsen/ 2014
Casasnovas 2011
Kasamon 2009
26
Author/
DLBCL
Study
PETAL
Sehn 2014
Outcome i-PET -/+
i-PET after
Number
Type +stage
Design
Year
33
2