{"entity":{"id":"fdg-pet-response-adapted-therapy","kind":"pairing","name":"FDG PET then response-adapted chemotherapy","aka":[],"tldr":"In Hodgkin lymphoma, a PET scan taken partway through chemotherapy is used to decide whether to keep the same treatment, drop a harsh drug, or step up to something stronger. Trials show this scan-guided approach keeps most patients well without adding one particular lung-damaging drug.","summary":"RATHL (Response-Adapted Therapy in advanced Hodgkin Lymphoma; NCT00678327; Johnson et al., NEJM 2016) enrolled 1214 patients (1119 evaluable) with stage IIB-IV or bulky IIA classical Hodgkin lymphoma. All patients received two cycles of ABVD chemotherapy and then an interim FDG PET-CT scan (PET2). Patients with a negative PET2 (Deauville score 1-3; 83.7% of scanned patients) were randomised to continue ABVD or to drop bleomycin (AVD) for the remaining four cycles; those with a positive PET2 were escalated to BEACOPP-14 or escalated BEACOPP, with no randomisation in that arm.\n\nAt a median follow-up of 41 months, 3-year progression-free survival in PET2-negative patients was 85.7% with continued ABVD versus 84.4% with AVD (absolute difference 1.6 percentage points, within the prespecified non-inferiority margin), while overall survival was around 97% in both arms; the trial's practical conclusion was that bleomycin can be safely omitted after a negative interim scan, reducing pulmonary toxicity with an estimated treatment-failure risk of only 1.6%. PET2-positive patients who were escalated to BEACOPP reached a 3-year progression-free survival of 67.5%, which the investigators judged better than historical rates of continuing ABVD alone in PET2-positive disease (previously reported in the 15-45% range). Long-term follow-up (Blood 2022; JCO 2024) confirmed durability of both the de-escalation and escalation strategies.\n\nRATHL is the paradigm case for FDG-PET-guided, response-adapted treatment and sits alongside other PET2-adapted trials (Italian GITIL/FIL HD0607, US Intergroup S0816) that validated the same principle: interim FDG-PET response predicts outcome and can be used prospectively to tailor chemotherapy intensity. The same logic (imaging mid-treatment to decide whether to change systemic therapy) generalises to other FDG-avid cancers, for example the germ-cell tumour and lymphoma literature more broadly, though the specific numbers above are for classical Hodgkin lymphoma.","asOf":"2026-09-22","links":[{"label":"Johnson P, et al. RATHL: adapted treatment guided by interim PET-CT, N Engl J Med 2016;374:2419-2429","url":"https://thd.org.tr/thdData/userfiles/file/RATHL_Adapted_Treatment_Guided_by_Interim_PET-CT_Scan-2016_NEJM.pdf"},{"label":"PMC review of PET-adapted approaches to primary therapy for advanced Hodgkin lymphoma","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC7268111/"},{"label":"Long-term follow-up of RATHL (Luminari et al., J Clin Oncol 2024)","url":"https://ascopubs.org/doi/10.1200/JCO.23.01177"}],"tags":["Hodgkin lymphoma","response-adapted therapy","FDG PET"],"related":["rathl","paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016","quantitative-imaging-biomarkers","pierre-vera"],"indications":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"fdg-pet","b":"pet-adapted-therapy","rationale":"FDG uptake after two cycles of chemotherapy predicts long-term outcome in Hodgkin lymphoma, so an interim scan can be used prospectively to de-escalate treatment for good responders (reducing toxicity) or escalate it for poor responders (improving control).","evidence":"RATHL (n=1214, NCT00678327): in interim-PET-negative patients, 3-year progression-free survival was 85.7% with continued ABVD vs 84.4% after dropping bleomycin (AVD), supporting safe de-escalation; interim-PET-positive patients escalated to BEACOPP reached 67.5% 3-year progression-free survival, better than historical rates with unmodified ABVD (Johnson et al., NEJM 2016).","pairingType":"platform"},"route":"/pairings/fdg-pet-response-adapted-therapy/","neighbours":{"trial":[{"id":"rathl","kind":"trial","name":"RATHL","route":"/trials/rathl/"}],"paper":[{"id":"paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016","kind":"paper","name":"RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma","route":"/key-papers/paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016/"}],"technology":[{"id":"fdg-pet","kind":"technology","name":"FDG PET","route":"/technologies/fdg-pet/"},{"id":"pet-adapted-therapy","kind":"technology","name":"PET-adapted (response-adapted) therapy","route":"/technologies/pet-adapted-therapy/"},{"id":"quantitative-imaging-biomarkers","kind":"technology","name":"Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC)","route":"/technologies/quantitative-imaging-biomarkers/"}],"person":[{"id":"pierre-vera","kind":"person","name":"Pierre Vera","route":"/people/pierre-vera/"}]}}