KEY TAKEAWAYS
- The RELEVANCE phase 3 trial aimed to investigate the prognostic value of baseline PET parameters in treatment-naïve FL patients.
- Researchers concluded that baseline TMTV serves as an independent predictor of PFS in advanced FL patients.
We investigated the prognostic value of baseline positron emission tomography (PET) parameters in treatment-naïve follicular lymphoma (FL) patients in the phase III RELEVANCE trial. A. S. Cottereau and his team aimed to compare the outcomes between the immunomodulatory combination of lenalidomide and rituximab (R2) and R-chemotherapy (R-chemo), followed by R maintenance therapy.
Researchers performed an inclusive analysis of baseline characteristics in the entire PET-evaluable population (n = 406/1032), ensuring a well-balanced distribution between treatment arms. The methodology involved extracting the maximal standard uptake value (SUVmax) and the standardized maximal distance between 2 lesions (SDmax), with the total metabolic tumor volume (TMTV) calculated using the 41% SUVmax method.
With a median follow-up of 6.5 years, the 6-year progression-free survival (PFS) for the entire PET-evaluable population (n = 406/1032) in the phase III RELEVANCE trial was 57.8%. The median TMTV was 284 cm3, SUVmax was 11.3, and SDmax was 0.32 m-1, demonstrating no significant difference between treatment arms. High TMTV (>510 cm3) and FLIPI were associated with an inferior PFS (P = 0.013 and P = 0.006, respectively), while SUVmax and SDmax showed no significant association (P = 0.08 and P = 0.12, respectively). In multivariable analysis, follicular lymphoma international prognostic index (FLIPI ) and TMTV remained significantly associated with PFS (P = 0.0119 and P = 0.0379, respectively). Combining these adverse factors stratified the population into 3 risk groups: no risk factors (40%), 1 factor (44%), or both (16%), with 6-year PFS rates of 67.7%, 54.5%, and 41.0%, respectively. No significant interaction was observed between treatment arms and TMTV or FLIPI (P = 0.31 or P = 0.59, respectively). The high-risk group (high TMTV and FLIPI 3-5) had similar PFS in both arms (P = 0.45) with a median PFS of 68.4% in the R-chemo arm versus 71.4% in the R2 arm.
The study concluded that baseline TMTV is an independent predictor of PFS in patients with advanced FL, even in antibody maintenance.
Source: https://pubmed.ncbi.nlm.nih.gov/37898239/
Cottereau AS, Rebaud L, Trotman J, et.al (2024). Metabolic tumor volume predicts outcome in patients with advanced stage follicular lymphoma from the RELEVANCE trial. Ann Oncol. 2024 Jan;35(1):130-137. doi: 10.1016/j.annonc.2023.10.121. Epub 2023 Oct 28. PMID: 37898239.
