10-Year Update of HD9 Study Finds BEACOPP Effective in Hodgkin's Lymphoma

Researchers with the German Hodgkin Study Group (GHSG) recently published an update to the GHSG HD9 study in the Journal of Clinical Oncology. The trial was initiated in 1993, when standard treatment for advanced Hodgkin’s Lymphoma (HL) consisted of cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) alternated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). The COPP/ABVD regimen was compared with a new regimen that added bleomycin, etoposide, and doxorubicin to COPP.

A total of 1196 assessable patients with newly diagnosed advanced HL were enrolled in the study and randomly assigned to one of three treatment arms: COPP/ABVD (n = 261), baseline BEACOPP (n = 469), or escalated BEACOPP (n = 466). The majority of patients in each arm had stage III bulky disease. Each patient received 8 cycles of chemotherapy.

At 10 years, patients in the BEACOPP escalated group had improved rates of freedom from treatment failure (FFTF) and overall survival (OS). FFTF was 64%, 70%, and 82%, respectively; and OS was 75%, 80%, and 86%, respectively (P <.001). BEACOPP escalated was significantly better than BEACOPP baseline for both endpoints. Although the 10-year FFTF rates were lower than those observed at 5 years, the superiority of BEACOPP baseline over COPP/ABVD was confirmed, as was the superiority of BEACOPP escalated over both regimens. Complete Response was seen in 85% of patients in the COPP/ABVD group, 88% in the BEACOPP baseline group, and 96% in the BEACOPP escalated group.

The study authors noted that since the study was initiated, ABVD alone has become the preferred treatment for HL; it offers similar rates of efficacy but reduced toxicity. They compared outcomes with the BEACOPP escalated regimen to outcomes from randomized trials investigating ABVD and concluded that BEACOPP “clearly results in significantly improved tumor control and OS in advanced-stage HL patients.” BEACOPP escalated was associated with more pronounced acute and long-term adverse effects, however. Nevertheless, the authors suggested it might challenge ABVD as a new standard of care in HL.

Causes of Death

COPP/ABVD

(n = 261), %

BEACOPP baseline

(n = 469), %

BEACOPP escalated

(n = 466), %

Hodgkin’s

11.5

8.1

2.8

Acute toxicity (1^st line)

1.9

1.5

1.7

Acute toxicity (salvage)

1.9

1.5

0.6

2^nd malignancy

3.1

3.6

3.2

Cardiorespiratory

1.2

0.9

0.9

Pulmonary

0.4

0.4

0.2

Other

3.8

3.0

2.1

Source: Adapted from Egert et al. J Clin Oncol. 2009;27(27):4548-4554.