What are the outcomes for advanced HL patients receiving intensified BEACOPP chemotherapy after ABVD chemotherapy?

This study investigated the outcomes of advanced-stage classical Hodgkin’s lymphoma (HL) patients treated with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by escalated (higher dose) BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) chemotherapy based on PET scan results. This study concluded that switching from ABVD to escalated BEACOPP therapy based on PET scan results is safe and effective in high-risk HL patients.

The most commonly used frontline chemotherapy regimen for advanced Hodgkin’s lymphoma (HL) is ABVD. Frontline chemotherapy for advanced HL aims to cure patients without needing more therapy. However, up to 30% of patients have refractory (does not respond to initial treatment) or relapsed disease after ABVD treatment. For these patients, alternative treatments are needed.

BEACOPP has been associated with 5 years without treatment failure in up to 90% of patients. However, it has more side effects than ABVD. Therefore, adapting treatments to individual patients is a major goal of care.

PET scanning can be used to customize treatment plans. This scanning is done after one or two cycles of chemotherapy. It has been shown to help predict treatment outcomes for advanced HL patients. Whether PET scanning can be used to reserve BEACOPP treatment for high-risk patients remains to be determined.

This study involved 782 patients with previously untreated advanced HL. Patients were at stage 2 (36%), stage 3 (32%), or stage 4 (32%).  All patients received ABVD chemotherapy, followed by PET scanning. Patients with positive PET results (19%, tumors still present) received escalated BEACOPP followed by standard BEACOPP with or without rituximab (Rituxan). Patients with negative PET results (81%, tumor shrinkage or disappearance) received additional ABVD or radiotherapy. The average follow-up period was 3.6 years.

The progression-free survival (time from treatment before disease progression) rate at 3 years was 82% for all patients, 87% (PET-), and 60% (PET+). The overall survival (time from treatment until death from any cause) rate at 3 years was 97% for all patients, 99% (PET-) and 89% (PET+).

No statistically significant benefit was found with patients who received rituximab with BEACOPP. 65% of patients receiving rituximab versus 63% of patients receiving BEACOPP only showed a complete response. 

41% of patients reported severe or life-threatening neutropenia (low white blood cell count) during ABVD treatment. 30% of patients reported severe or life-threatening blood-related side effects during ABVD treatment. 76% of patients reported severe or life-threatening blood-related side effects during BEACOPP treatment.

This study concluded that using PET scan results to switch from ABVD to escalated BEACOPP therapy based is a safe and effective strategy in high-risk HL patients.

In this study, only 413 of 780 (53%) of PET scans taken after ABVD chemotherapy were analyzed. This may limit the conclusions that could be drawn from the results.

If you have advanced, high-risk HL, talk to your care team about having PET scans to determine if BEACOPP chemotherapy is right for you instead of ABVD.