In the EORTC 20012 randomized phase III trial comparing eight cycles of ABVD vs eight cycles of BEACOPP, Hodgkin lymphoma patients achieved equivalent overall survival with either regimen, but BEACOPP was more toxic.1
“Our approach, and that of most U.S. centers, is to use ABVD,” Michael E. Williams, MD, of the University of Virginia Cancer Center in Charlottesville said at the Best of ASCO Boston meeting. “It is best to treat with full doses on schedule. You don’t need cytokine support, which may reduce the risk of bleomycin pulmonary toxicity, and you can treat through the neutropenia by using prophylactic antibiotics.”
Significant Risk Reduction at 4 Years
The study compared an escalated BEACOPP 4+4 regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone) to eight cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) without radiotherapy in 549 high-risk stage III-IV Hodgkin lymphoma patients. While complete responses were observed in 83% of each arm, a highly significant difference in progression-free survival emerged at 4 years: 69.4% with ABVD vs 84.0% with BEACOPP, a 50% reduction in risk (P = .0003).
Mortality risk was reduced by 29% with BEACOPP, but this was not statistically significant. Overall survival at 4 years was 86.7% with AVBD and 90.3% with BEACOPP (P = .208). This confirms the findings of a recent Italian study in which overall survival at 7 years was 89% and 88%, respectively.2
“In this high-risk group, conventional dose escalation with BEACOPP 4+4 has better progression-free survival than ABVD, yet it is not good enough to improve overall survival,” he noted. Early treatment discontinuations were recorded for 13.9% of the BEACOPP arm vs 10.5% of the ABVD arm, and progression or relapse was observed in 7.7% vs 12.7%, respectively.
Both Highly Effective Regimens
Additional considerations, he said, may guide physician and patient treatment decisions between the regimens: treatment burden and costs, fertility issues, risk of relapse, risk of salvage treatment and immediate and late morbidities.
“Both regimens are highly effective and can currently share the claim for the ‘current standard of care,’” Dr. Williams concluded. “In the future, we will utilize risk-adapted therapy based on interim PET results. This will allow us to tailor therapy so we don’t overtreat patients, yet maintain high cure rates by minimizing early and late toxicities.” ■
Disclosure: Dr. Williams reported no potential conflicts of interest.
References
1. Carde PP, Karrasch M, Fortpied C, et al: ABVD (8 cycles) versus BEACOPP (4 escalated cycles ≥ baseline) in stage III-IV high-risk Hodgkin lymphoma: First results of EORTC 20012 Intergroup randomized phase III clinical trial. 2012 ASCO Annual Meeting. Abstract 8002. Presented June 2, 2012.
2. Viviani S, Zinzani PL, Rambaldi A, et al: ABVD versus BEACOPP for Hodgkin’s lymphoma when high-dose salvage is planned. N Engl J Med 365:203-212, 2011.
