Patients with advanced Hodgkins lymphoma received
greater benefit from treatment with lower-intensity BEACOPP and experienced
fewer toxicities than those treated with higher-intensity regimens, results of
a phase 3 study showed.
The randomized, open-label, non-inferiority study
randomly assigned patients to receive either eight cycles of a standard
chemotherapy regimen with radiotherapy or six cycles of the regimen plus
radiotherapy. BEACOPP14 is given in 2-week intervals in contrast to BEACOPP
escalated, which is given in 3-week intervals. The dose of various drugs is
higher in the escalated regimen as compared to the baseline version used in
Patients were assigned to six cycles of BEACOPP
escalated (6xBesc; n=711), eight cycles of BEACOPP escalated (8xBesc; n=705) or
eight cycles of a lower-dose variant BEACOPP14 (8xB14; n=710).
Results indicated that 5-year freedom from treatment
failure was noninferior between the 6xBesc group (89.3%) and the 8xB14 group
(85.4%) and the 8xBesc group (84.4%). In addition, the OS for patients treated
with 6xBesc was significantly better than those treated with 8xBesc (95.3% vs.
Finally, those patients assigned to the 8xBesc group had
a significantly increased mortality (7.5%) as compared with those patients
treated with 6xBesc (4.6%) and 8xB14 (5.2%)
Six cycles of BEACOPP escalated should be the
treatment of choice for advanced-stage Hodgkins lymphoma, the
researchers wrote. PET done after chemotherapy can guide the need for
additional radiotherapy in this setting.
In an accompanying editorial, Olivier Casanovas,
MD, of the Hopital le Bocage in Dijon, France, and Bertrand Coiffier,
MD, of the Center Hospitalier Lyon-Sud in France, wrote: Although an
important step has been reached towards improvement of the balance of efficacy
and toxicity with the upfront BEACOPP escalated regimen in patients with
advanced Hodgkins lymphoma, the future will require additional efforts to
identify patients needing fewer than six cycles of BEACOPP escalated.
- Engert A. Lancet. 2012;doi:10.1016/S0140-6736(12)60153-6.