PET-adapted (response-adapted) therapy
Scan after two cycles of chemotherapy; if the tumour has gone dark, give less treatment, and if not, give more. Hodgkin lymphoma pioneered this.
Interim FDG-PET after cycle 2 (PET2) scored on the Deauville scale steers escalation or de-escalation: RATHL (omit bleomycin if PET2-negative, no loss of efficacy), HD18 (shorten escalated BEACOPP), HD16/HD17 and RAPID (omit radiotherapy in early stage if PET-negative, at a small PFS cost), and HD21/S1826 (PET-guided consolidation). Being extended to DLBCL and to ctDNA-adapted designs.
How it works
FDG-PET measures metabolic response early; Deauville ≥4 at PET2 predicts failure, allowing therapy to be tailored before completion.
- Spares most patients bleomycin, radiation or intensified chemotherapy
- Identifies the minority who need escalation
- Interim PET has imperfect positive predictive value (many PET2-positive patients are cured anyway)
- Omitting radiotherapy trades a few percent PFS for late-toxicity avoidance
Latest papers
topQuery for this technology: (TITLE:"PET-adapted response-adapted therapy" OR ABSTRACT:"PET-adapted response-adapted therapy") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about PET-adapted (response-adapted) therapy, not a curated reading list.