Tatyana Feldman, MD, hematologist and medical oncologist, John Theurer Cancer Center, discusses the utility of PET scan in Hodgkin Lymphoma.

 Patients with Hodgkin lymphoma may develop residual masses in the mediastinum, making it difficult to differentiate active disease from scar tissue with a CAT scan, says Feldman. 

As such, patients were historically overtreated and radiation was commonly used, explains Feldman. Additionally, splenic disease was not often detected with CAT scan. 

PET scan was a major advancement in this field, says Feldman. Moreover, the majority of patients who have negative PET scan results after 2 cycles of chemotherapy are considered cured. 

Multiple randomized phase III trials have demonstrated the utility of PET scan, says Feldman. Patients with bulky disease or early-stage disease may be spared radiation therapy or receive deescalated chemotherapy based on PET scan results. 

As there are some limitations to PET scan, circulating tumor DNA testing may provide an alternative modality to accurately evaluate complete responses versus progressive disease in patients with Hodgkin lymphoma.

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Tatyana Feldman, MD, discusses the utility of PET Scan in Hodgkin Lymphoma.

Dr. Feldman on the Utility of PET Scan in Hodgkin Lymphoma

Tatyana Feldman, MD, hematologist and medical oncologist, John Theurer Cancer Center, discusses the shortcomings of PET scan in Hodgkin lymphoma.

About 80% of patients who have negative PET scan results after 2 cycles of doxorubicin, vinblastine, dacarbazine, and bleomycin (ABVD; PET2) are considered cured regardless of whether there is residual disease, says Feldman. However, a PET scan cannot identify the PET2-negative patients who will relapse, adds Feldman.

Additionally, combination approaches need to be fleshed out to determine which individuals are best suited for which regimen. For example, certain patients with positive scans may not require further treatment, says Feldman. However, certain patients with positive scans may need additional treatment, and there is no way to tell which category a patient will fall into with a PET scan. Novel agents may place a role for patients who need additional therapy. Further research may shed light on ways to avoid overtreatment as well as optimal treatment strategies for patients with residual disease.

Tatyana Feldman, MD, discusses the shortcomings of PET scan in Hodgkin lymphoma.

Dr. Feldman on the Shortcomings of PET Scan in Hodgkin Lymphoma

Tatyana Feldman, MD, a hematologist and oncologist specializing in lymphoma at the John Theurer Cancer Center at Hackensack University Medical Center, discusses the phase II multicenter trial examining the introduction of pegylated liposomal doxorubicin (PLD) followed by bexarotene for patients with advanced cutaneous T-cell lymphoma (CTCL).

Patients with advanced or refractory CTCL received 8 doses of PLD every 2 weeks. After the 16-week process response rate was gathered to gauge the efficacy of single agent PLD. If the patients responded they would receive an additional 16 weeks of oral bexarotene, an antineoplastic agent that is an retinoic acid receptor antagonist, which has demonstrated a 50% overall response rate (ORR) in relapsed or refractory CTCL.

Once treatment is stopped for patients with CTCL the disease generally recurs. The goal of the trial was to prolong the effects of bexarotene in order to extend progression-free survival (PFS). The median PFS in the trial was 4.82 months with an ORR of 41%.

Dr. Tatyana Feldman, from the John Theurer Cancer Center, Discusses Using Doxil for CTCL

Dr. Feldman Discusses Using Doxil for CTCL

Tatyana Feldman, MD, a hematologist and oncologist who specializes in lymphoma at John Theurer Cancer Center at Hackensack University Medical Center in Hackensack, NJ, discusses how difficult it is to treat rare forms of lymphoma. Many of these cases are diagnosed in early stages and pose more of a nuisance to the patient, but later stages are very serious, and there are not as many good therapies that exist for treating this relatively small population of patients.

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Dr. Tatyana Feldman from John Theurer Cancer Center Discusses the Difficulties of Rare Lymphomas

Tatyana Feldman, MD

Articles

Dr. Feldman on the Utility of PET Scan in Hodgkin Lymphoma

Dr. Feldman on the Shortcomings of PET Scan in Hodgkin Lymphoma

Dr. Feldman Discusses Using Doxil for CTCL

Dr. Feldman Discusses the Difficulties of Rare Lymphomas