EHA 2013: BEACOPP Beats ABVD for Advanced Stage Hodgkin's

The debate in the hematology community over which frontline therapy for advanced stage Hodgkin's lymphoma continues, with the latest salvo coming out of the European Hematology Association (EHA) annual meeting.

At the upcoming meeting of the EHA, German and Swiss researchers, including some from the German Hodgkin's Study Group, will report on a systematic review and network meta-analysis they carried out to determine the efficacy and safety of the two primary front-line therapies for advanced-stage Hodgkin's patients in order to determine a "hierarchy of regimens" for this patient population.

In other words, they wanted to see if they could look through the literature and see if they could arrive at some high-level evidence supporting one over the other.

Research

The researchers looked at two combination chemotherapy treatments:

1. BEACOPP escalated (Bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) and BEACOPP-14
2. ABVD (doxorubicin, bleomycin, vincristine, dacarbazine)

The primary endpoint was overall survival, but they also looked at freedom from treatment failure.

They searched several databases, including not just published studies but also conference proceedings, and they obtained any missing data from researchers. Between January of 1980 and September of 2012, they found 2,229 relevant references involving 74 publications with 14 randomized, controlled trials evaluating 11 different regimens.

Findings

In short, they determined that six cycles of escalated BEACOPP, or eight cycles of BEACOPP-14, were very likely (98 percent probability) to be the best regimens for these patients over ABVD. Notably, six cycles of escalated BEACOPP amounted to a 10 percent increase over ABVD in overall survival after five years.

Because secondary cancers from treatment for Hodgkin's is a significant problem, investigators also looked into whether one regimen offered benefits over the other in this regard as well. Despite the data, they were unable to quantify the risks for each regimen.

Investigators ultimately determined that for advanced stage Hodgkin's patients, there is a relevant survival benefit in both FFTF and OS with six cycles of the escalated BEACOPP as well as and eight cycles of BEACOPP-14 over standard ABVD, adding that the "overall survival difference to ABVD is not only highly significant but also relevant for patients with advanced stage HL."

This is an abstract being reported at a scientific meeting. Its results should be considered preliminary until published in a peer-reviewed journal.

Source: EHA Abstracts