ASH 2025 | FDG-PET in the prognostication of Hodgkin lymphoma treated with nivolumab-AVD: sub-analysis of S1826

This year at ASH, we present the radiology kind of secondary analysis of sequentially reviewed PET scans from the S1826 study. And we show that even though PET scans at interim, so after two cycles of nivolumab, AVD, or brentuximab vedotin, AVD, and at end of treatment, certainly are prognostic for outcome. You know, in truth, the differences in patients who are PET negative or PET positive at interim actually weren’t too large. PET positive patients still did quite well. Their progression-free survival after three years was about 84%. And so, you know, in truth, perhaps with more novel agents and immunotherapy included in the frontline regimens, PET scans aren’t the best way to discriminate high-risk patients. And really based on the outcomes that we saw in patients who are PET positive, probably don’t justify a change in therapy. For many years, PET adapted therapy was a standard in Hodgkin lymphoma. but I think with the nivolumab AVD, PET scans probably aren’t going to be a good enough discriminator of future outcome, certainly at the interim time point, to guide therapy. Interestingly, at the end of treatment time point, although PET scans certainly performed better, if a positive PET scan at end of treatment was prognostic. Actually, there was a majority of patients still were progression-free at three years, even though they had a positive PET scan at the end of treatment. So I think what we learned a lot, actually, about the imperfections of PET, and really it’s probably not the best tool to use in many ways when we’re thinking about assessing response and prognosis within the nivolumab AVD. We do have other tools like circulating tumor DNA and in our study circulating tumor DNA actually outperformed PET from a prognostic perspective.

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