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ICML 2025 | Interim PET-adapted treatment reduction in older patients with DLBCL and favorable prognosis
In this video, Lorenz Thurner, MD, Saarland University Medical Center, Homburg, Germany, discusses a trial that evaluated interim PET-adapted treatment reduction in elderly patients with diffuse large B-cell lymphoma (DLBCL) aged 60 and above with favorable prognosis (NCT01478542). Dr Thurner highlights that the outcomes with PET-guided de-escalation in this patient population were encouraging. This interview took place during the 18th International Conference on Malignant Lymphoma (18-ICML) in Lugano, Switzerland.
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Transcript
So we already knew from the RICOVER-60 trial that patients with IPI1, so only age above 60, a single risk factor have a very good outcome. And from the younger patients, 18 to 60, from the FLYER trial, we knew that de-escalation to four cycles is safe, but the FLYER trial was without PET-guided therapy. So there were some other trials in favorable patients like the NCTN S1001 trial which was PET-3 guided or the French LNH2009-1B trial which was PET-2 and 4 guided or the trial from Shanghai, Xi et al, which was PET-4 guided and they all showed, they all showed that de-escalation, PET-guided de-escalation is safe for patients...
So we already knew from the RICOVER-60 trial that patients with IPI1, so only age above 60, a single risk factor have a very good outcome. And from the younger patients, 18 to 60, from the FLYER trial, we knew that de-escalation to four cycles is safe, but the FLYER trial was without PET-guided therapy. So there were some other trials in favorable patients like the NCTN S1001 trial which was PET-3 guided or the French LNH2009-1B trial which was PET-2 and 4 guided or the trial from Shanghai, Xi et al, which was PET-4 guided and they all showed, they all showed that de-escalation, PET-guided de-escalation is safe for patients. These trials didn’t focus on elderly patients, they included patients from 18 to 80 or 75, but they all showed that de-escalation is safe. So, the OPTIMAL>60 trial, the favorable trial included 288 patients and the PET-guided de-escalation was safe and resulted in an excellent outcome. Regarding a different question of the trial, it was reducing neurotoxicity by liposomal vincristine that was negative so the neurotoxicity was not reduced what is also interesting about this trial is that PET-positive patients had a very good outcome and we think due to two additional cycles of chemotherapy plus involved-site radiotherapy to all initially involved sites.
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