Reduced Escalated BEACOPP More Effective, Less Toxic in Hodgkin Lymphoma

(ChemotherapyAdvisor) – Six cycles of escalated BEACOPP followed by PET-guided radiotherapy are more effective and less toxic compared to eight cycles in patients with advanced stage Hodgkin lymphoma, according to an international team of researchers. The conclusion is based on an abstract entitled “Comparing Intensity of Chemotherapy Followed PET-guided Radiotherapy in Patients with Advanced Stage Hodgkin Lymphoma: Final Results of the GHSG HD15 Trial,” which was presented at the 17^th Annual Congress of the European Hematological Association in Amsterdam, The Netherlands.  

Intensified chemotherapy with eight cycles of escalated BEACOPP in advanced stage Hodgkin lymphoma (HL) is highly effective, but toxic; in addition, the need for radiotherapy in this setting is unclear, noted lead author Andreas Engert, MD, University Hospital of Cologne, Cologne, Germany. Reducing toxicity without losing efficacy was the main goal of the current prospective, randomized, HD15 trial.

In this five-year trial, 2,182 patients were randomized to receive either eight cycles of escalated BEACOPP (8B_esc), six cycles of escalated BEACOPP (6B_esc), or eight cycles of BEACOPP₁₄ (8B₁₄). When chemotherapy was completed, those patients in whom a partial response (PR) was assessed by PET scan received additional radiotherapy (RT) with 30Gy.

Complete response (CR) was achieved in 90.1% of patients after 8B_esc, in 94.2% after 6B_esc and in 92.4% after 8B₁₄ (P=0.01). Five-year overall survival was 91.9%, 95.3%, and 94.5%, respectively, and was also better with 6B_esc compared to 8B_esc (97.5% CI, 0.2% to 6.5%). Hematological toxicities occurred in 92.4% (8B_esc), 91.7% (6B_esc), and 79.7% (8B₁₄) of cases. After a median follow-up of 48 months, there were 53 deaths (7.5%) in the 8B_esc group, 33 (4.6%) in the 6B_esc group and 37 (5.2%) in the 8B₁₄ group. There were 72 secondary cancers including 29 secondary AML/MDS, 19 (2.7%) after 8B_esc, 2 (0.3%) after 6B_esc and 8 (1.1%) after 8B₁₄.

The investigators concluded that “critical toxicities observed with eight cycles were reduced with six cycles of escalated BEACOPP. PET performed after chemotherapy can guide the need of additional RT in this setting and reduces the number of patients requiring RT.”

Abstract