Source: DGNews  |  Posted 4 years ago

By John Gever

ATLANTA, GA -- December 10, 2007 -- Intensifying a standard chemotherapy regimen in patients with poor-prognosis Hodgkin's lymphoma significantly improved 10-year overall survival and freedom from treatment failure, according to results from a randomized study of nearly 1,200 patients.

The results were presented at a press briefing here on December 9 at the 49th American Society of Hematology (ASH) Annual Meeting and Exposition by Volker Diehl, MD, Professor of Hematology and Oncology, University of Cologne, Cologne, Germany.

An escalated version of the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) produced a 10-year overall survival rate of 86%. Ten-year survival with standard BEACOPP was 80%, and it was 75% with a regimen based on COPP (cyclophosphamide, vincristine, procarbazine, and prednisone) alternating with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine).

Escalated BEACOPP led to a significantly improved 10-year rate of overall survival over standard BEACOPP (86% vs 80%, P =.0053) and over COPP-ABVD (75%, P <.001).

Similarly, for increasing 10-year freedom from treatment failure, escalated BEACOPP was significantly better than either of the other regimens, with a rate of 82% versus 70% for standard BEACOPP (P <.0001) and 64% for COPP-ABVD (P <.001).

In escalated BEACOPP, doses of etoposide, doxorubicin, and cyclophosphamide per cycle were increased over the standard version. The differences were 200 versus 100 mg/m² for etoposide, 35 versus 25 mg/m² for doxorubicin, and 1,200 versus 650 mg/m² for cyclophosphamide.

The 1,196 evaluable patients in the study had newly diagnosed and untreated Hodgkin's lymphoma at stage IIA or beyond, with complications such as splenic involvement or large mediastinal mass predicting poor outcome.

Evaluable patients in each treatment group numbered 466 for escalated BEACOPP, 469 for standard BEACOPP, and 261 for COPP-ABVD. Enrollment in the latter arm was stopped early when its inferiority to the BEACOPP treatments became apparent.

Similar results were reported in a 5-year analysis of these patients published in 2000, except that the survival advantage for escalated versus standard BEACOPP was not significant. Overall survival rates at that time were 91%, 88%, and 83% for escalated BEACOPP, standard BEACOPP, and COPP-ABVD, respectively.

Dr. Diehl noted that second malignancies such as myelodysplastic syndrome and acute myeloid leukemia are a concern with these regimens.

The 10-year data from his group's study showed rates of 3.1%, 3.6%, and 3.2% for COPP-ABVD, standard BEACOPP, and escalated BEACOPP, respectively.

He added that escalated BEACOPP has since been used in more than 2,500 patients in two other European trials. "The leukemia rate dropped down to 0.9%," he said. Patients had leukemia and Hodgkin's lymphoma simultaneously, he said, indicating that the treatment was not responsible.

[Presentation title: Long-Term Follow-Up of BEACOPP escalated Chemotherapy in Patients With Advanced-Stage Hodgkin Lymphoma on Behalf of the German Hodgkin Study Group. Abstract 211]