ABVD, BEACOPP Demonstrate Similar Survival Advantage in Advanced-stage Hodgkin Lymphoma

Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) resulted in similar event-free survival and overall survival in patients with high-risk advanced-stage Hodgkin lymphoma, a study published in the Journal of Clinical Oncology has shown.¹

For the study, researchers enrolled 549 patients with clinical stage III or IV Hodgkin lymphoma between 2002 and 2010. All patients had an International Prognostic Score of 3 or higher and were aged 60 years or younger. Of those, 74% had stage IV disease, 81% were experiencing “B” symptoms, and 59% had an International Prognostic Score of 4 or higher.

Participants were randomly assigned 1:1 to receive ABVD for 8 cycles or escalated-dose BEACOPP for 4 cycles followed by baseline BEACOPP for 4 cycles without radiotherapy.

Results showed that at a median follow-up of 3.6 years, 82.5% of patients in both arms achieved a complete response or an unconfirmed complete response.

Further, researchers found that at 4 years, event-free survival was 63.7% for ABVD compared with 69.3% for BEACOPP (HR, 0.86; 95% CI, 0.64 – 1.15; P = .312). Disease-free survival was 85.8% and 91.0%, respectively (HR, 0.59; 95% CI, 0.33 – 1.06; P = .076).

Overall survival was 86.7% with ABVD vs 90.3% with BEACOPP (HR, 0.71; 95% CI, 0.42 – 1.21; P = .208).

In regard to safety, 6 patients who received ABVD and 5 patients who were administered BEACOPP died as a result of toxicity. Early discontinuation occurred in 12 and 26 patients, respectively. Of note, 8 patients in the ABVD arm and 10 in the BEACOPP arm developed secondary malignancies.

“Because BEACOPP did not demonstrate a favorable effectiveness or toxicity ratio compared with ABVD, treatment burden, immediate and late toxicities, and associated costs must be considered before selecting one of these regimens on which to build future treatment strategies,” the authors concluded.

Reference

1. Carde P, Karrasch M, Fortpied C, et al. Eight cycles of ABVD versus four cycles of BEACOPP_escalated plus four cycles of BEACOPP_baseline in stage III to IV, International Prognostic Score ≥ 3, high-risk Hodgkin lymphoma: first results of the phase III EORTC 20012 Intergroup trial [published online ahead of print April 25, 2016]. J Clin Oncol. doi: 10.1200/JCO.2015.64.5648.