Savage KJ et al. Proc ASH 2015;Abstract 579.

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Savage KJ et al. Proc ASH 2015;Abstract 579. Advanced Stage Classical Hodgkin Lymphoma Patients with a Negative PET-Scan Following Treatment with ABVD Have Excellent Outcomes without the Need for Consolidative Radiotherapy Regardless of Disease Bulk at Presentation Savage KJ et al. Proc ASH 2015;Abstract 579.

Outcomes in Advanced-Stage Classical Hodgkin Lymphoma (cHL) with a Negative PET Scan After ABVD Retrospective study from British Columbia Cancer Agency Centre comparing outcomes after ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine) by PET status N = 316 patients with advanced-stage cHL (Stage I bulky [>10 cm], Stage II with B symptoms and/or bulky disease and all Stage III/IV) treated with curative intent using ABVD who underwent a restaging PET scan at the end of treatment Primary endpoint: Freedom from treatment failure (FFTF) PET negative (n =261) PET positive (n = 49) p-value Five-year FFTF 89.0% 53.0% <0.0001 Bulky (n = 112) Nonbulky (n = 152) 88.5% 0.5 Savage KJ et al. Proc ASH 2015;Abstract 579.

British Columbia Cancer Agency Study: Conclusions Patients with advanced-stage cHL, including those with bulky disease, who have a negative PET scan after ABVD chemotherapy have excellent outcomes without additional consolidative radiation therapy (RT), thus potentially avoiding long-term effects. RT may be useful for select responding patients with PET-positive residual uptake: For those who were able to receive consolidative RT (n = 41), the 5-y FFTF was 60% and the 5-y overall survival was 94%. For those with mediastinal PET-positive disease who received RT (n = 29, 72% with bulky disease at diagnosis), the 5-y FFTF was 69.5%. With a PET-guided approach, the need for RT has been significantly reduced. Savage KJ et al. Proc ASH 2015;Abstract 579.

Investigator Commentary: Clinical Outcomes for Patients with Advanced cHL with a Negative PET Scan After ABVD Kerry Savage and colleagues presented data from a retrospective trial conducted by the British Columbia Cancer Agency evaluating the need for consolidative RT for patients who have negative PET scans after treatment with ABVD. Patients with a PET-negative scan after completion of chemotherapy had a 5-year FFTF rate of 89%, and the rate was 53% for patients with a PET-positive scan after completion of chemotherapy. Among the patients with PET-negative scans, no difference was observed in the 5-year FFTF rate between patients who presented with bulky disease and those who presented with nonbulky disease. The 5-year overall survival rate was 94.5% for the entire study cohort, and only 2 patients out of 261 with PET-negative status after chemotherapy received consolidative RT. Continued

Investigator Commentary: Clinical Outcomes for Patients with Advanced cHL with a Negative PET Scan After ABVD Thus, outcomes were good for patients with advanced-stage disease and negative PET scans after chemotherapy. Also, disease bulk did not influence these outcomes. These results support an ongoing CALGB/Alliance study designed to evaluate treatment with ABVD alone in patients with early-stage, bulky mediastinal, PET-negative cHL. Data from this study will be important in answering the question, is radiation therapy really needed in all cases for patients with bulky mediastinal disease? Interview with Michelle A Fanale, MD, February 18, 2016