(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 17th 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 (8Besc), six cycles of escalated BEACOPP (6Besc), 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.

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Complete response (CR) was achieved in 90.1% of patients after 8Besc, in 94.2% after 6Besc 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 6Besc compared to 8Besc (97.5% CI, 0.2% to 6.5%). Hematological toxicities occurred in 92.4% (8Besc), 91.7% (6Besc), and 79.7% (8B14) of cases. After a median follow-up of 48 months, there were 53 deaths (7.5%) in the 8Besc group, 33 (4.6%) in the 6Besc group and 37 (5.2%) in the 8B14 group. There were 72 secondary cancers including 29 secondary AML/MDS, 19 (2.7%) after 8Besc, 2 (0.3%) after 6Besc 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.”