Using a PET scan to analyse a tumour leads to better treatment of Hodgkin’s lymphoma, a cancer of the white blood cells known as lymphocytes. The technique has been studied and validated by the team of Professor Marc André, head of the haematology department at CHU UCL Namur at Godinne.
Characterised by the presence of abnormal cells called Reed-Sternberg cells, Hodgkin’s lymphoma is a cancer of the white blood cells known as lymphocytes. It affects approximately four of every 100,000 people, especially young adults and the elderly. While in 80% of cases the standard treatment leads to very good results, the remaining 20% do not respond as well as hoped. ‘These patients are less responsive to the standard treatment, which is a chemotherapy called ABVD’, Professor André explains. ‘Fortunately, a second, more intense treatment called BEACOPP can overcome this lack of responsiveness.’ But how do doctors know who should receive this treatment?
Avoiding unnecessary side effects
‘We might imagine administering this stronger treatment to all patients to attain 100% success. But BEACOPP treatment induces much more severe side effects that we would rather prevent our patients from experiencing if the standard treatment works for them. For example, BEACOPP treatment carries a greater risk of causing fertility disorders and infections.’ Thus Professor André and his team led the development of a technique for identifying the patients least responsive to standard treatment, by using PET scans to determine all patients’ responses to standard treatment.
PET scan: easily accessible tool
The advantage of the PET scan is its ease of use: it’s been used for many years in diagnosing cancers, and more and more hospitals have them. There’s no need to train health professionals to analyse the images – they already do it every day. Moreover, it’s a very good baseline test for assessing the stage of the illness before and after treatment. ‘As part of this international study carried out in collaboration with French, Italian, Dutch and Danish colleagues, we used the PET scan to analyse the tumour’s development after two ABVD chemotherapy treatments. If the tumour disappeared, it proved the patient responded well to standard treatment and he continued with it. If the tumour was still present, the patient was placed into one of two groups: the first continued the ABVD chemotherapy; the second switched to BEACOPP chemotherapy.’
Lower relapse rate in BEACOPP group
The experimental strategy paid off: resistant patients who underwent BEACOPP treatment had a greater survival rate without relapse at five years. ‘And our results are particularly robust because in 80% of cases, the relapses usually occur during the first two years following the end of treatment’, Professor André says. He emphasises the patients’ role in this discovery: ‘Without them, it would have been impossible to achieve this type of study and its medical advances. We’re really lucky to be able to count on them, very few refused to participate.’
Adapting guideline
Because of this work, Hodgkin’s lymphoma care standards must be reviewed immediately. ‘From now on, every patient will be prescribed a PET scan after the first two standard chemotherapy sessions, and based on the scan results the rest of his treatment will be re-evaluated. Treatment can be adapted rapidly and easily’. The study was published in the Journal of Clinical Oncology.
Elise Dubuisson
This research was achieved thanks to the financial support of the following: European Organisation for Research and Treatment of Cancer (Belgium), Lymphoma Study Association (France), Fondazione Italiana Limfomi (Italy), Fondation Belge contre le Cancer (Belgium), Dutch Cancer Society (the Netherlands), Institut National du Cancer (France), Assistance Publique des Hopitaux de Paris (France), Societe Française de Medecine Nucleaire et Imagerie Moleculaire (France), Associazone Angela Serra (Italy), van Vlissingen Lymfoom Fonds (the Netherlands), and Chugai Pharmaceutical (Japan).
A glance at Marc André's bio
1989 : Doctor of Medicine, UCL
1994-1995 : Haematology Intern, Institut Saint-Louis, Paris, France
1995 : UCL Internist
1995-2011 : Department of Haematology, Grand Hôpital de Charleroi, Belgium
Since 2006 : Member of LYSA (LYmphoma Study Association) Scientific Committee
Since 2011 : Department of Haematology, CHU UCL Namur at Godinne, Belgium