Looking at another ASCO presentation. This one looks into whether a PET scan can do a better job of detecting disease after treatment has been given to see if there was a complete response.
The presentation is called "Effect of FDG-PET–based bone marrow assessment on prognostic accuracy compared to conventional histologic evaluation in patients with follicular lymphoma: A subanalysis of the FIL FOLL12 trial."
The research comes from the phase 3 FIL FOLL 12 clinical trial. In the trial, 189 patients received a PET scan and then either Bendamustine + Rituxan or R-CHOP. After 6 rounds of treatment, patients received another PET scan as well as a Bone Marrow Biopsy. Patients who received a negative scan (no evidence of disease) were given Rituxan maintenance. Those who had a positive scan (some disease showed up), were given a second treatment, decided on by their oncologist.
I think it's important to point out all of those details. It's a good reminder that, no matter what a clinical trial is trying to prove, patients are taken care of. There's a plan in place whether a patient's treatment is successful or not.
This particular ASCO presentation focused on those PET scans and whether or nor they could replace a Bone Marrow Biopsy (BMB).
My guess is that most of us have had a BMB. If you're lucky enough to not know what it is, a BMB is part of the standard bunch of tests that are given at diagnosis. A BMB involves having sample of bone marrow removed from the patient's hip. If cancer cells are present in the bone marrow, it affects staging -- FL cells in the bone marrow mean the disease is at stage 4. That often (but not always) affects treatment timing and type. But it also depends on some other factors. Bone marrow is in the center of the bone, so it takes a little work to get it out. I won't get into details. It's not a fun procedure.
So anything that keeps a patient from getting a BMB is a good thing.
Researchers found, in compari g the results of the post-treatment PETs and BMBs, that not only did the PET scans do as good a job in identifying disease, it actually did a better job -- 8 patients who had no evidence of disease in the BMBs did have evidence of disease on their scans.
Perhaps more importantly, the positive PET scan had longer-term implications. Patients with a positive BMB had a 33% Five Year Progression-Free Survival (PFS). That is, about a third of them went 5 years without seeing their disease progress. However, the patients with a positive PET scan and a negative BMB had a 74% Five Year PFS, and those with a negative BMB and negative PET had a 66% 5Year PFS. In other words, patients who had disease show up on their PET scans had their disease identified earlier, and were able to get it treated earlier.
My initial reaction to this was to be happy that patients might be able to avoid a Bone Marrow Biopsy. But then I was a little skeptical -- I'm not a fan of BMBs, but I'm ever less of a fan if PET scans, given how much radiation they result in. But I thought about it some more, and I'm OK with this. The research is looking at a very specific situation -- a PET scan before and after treatment along with a BMB after treatment. Patients are going to receive a PET scan before and after treatment anyway -- there's really no better way to measure if a treatment has been successful. I'd be a little more skeptical if they were suggesting that PET scans could be used for surveillance, maybe giving a patient a scan once year or something like that. That would be a bad idea. But in this context, measuring treatment success, it makes sense.
This is another small study, in the sense that it isn't moving us forward in terms of treatment. But it might improve the Quality if Life for some patients, and that's a great thing, too.
More ASCO reviews to come.
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