(ChemotherapyAdvisor) – Six cycles of BEACOPPescalated chemotherapy — vs. 8 cycles — followed by PET-guided radiotherapy should be the treatment of choice for patients with advanced stage Hodgkin’s lymphoma, according to a study reported in the Lancet online April 3.

The investigators randomized 2,182 patients. BEACOPP14 is given in two-week intervals; BEACOPPescalated is given in three-week intervals. Dose of various drugs is higher in the BEACOPPescalated regimen vs. the “baseline” version used in BEACOPP14. The authors evaluated two different approaches to reduce toxicity of chemotherapy: one approach used six cycles of treatment (6xBEACOPP escalated; Arm A) instead of eight (the old standard; Arm B); the other used the lower dose variant (BEACOPP14; Arm C) given at shorter time intervals.

“Treatment with six cycles of BEACOPPescalated followed by PET-guided radiotherapy was more effective in terms of freedom from treatment failure and less toxic than eight cycles of the same chemotherapy regimen,” they wrote, including better overall survival and superior tumor control.

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A total of 2,126 patients were included in the intention-to-treat analysis set: 711 in Arm A, 705 in Arm B, and 710 in Arm C. Freedom from treatment failure was sequentially noninferior for Arms B and C vs. Arm A. Five-year freedom from treatment failure rates were 89% for Arm A, 84% for the Arm B, and 85% for Arm C. Overall survival in the three groups was 95%, 92%, and 95% respectively, and was significantly better with Arm A than with Arm B. Arm C showed a higher mortality (8%) than the Arm A (5%) and Arm B (5%) groups, mainly due to differences in treatment-related events and secondary cancers.

A linked comment noted that “although an important step has been reached toward improvement of the balance of efficacy and toxicity with the upfront BEACOPPescalated regimen in patients with advanced Hodgkin’s lymphoma, the future will require additional efforts to identify patients needing fewer than six cycles of BEACOPPescalated.”