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BEACOPP more effective than COPP-ABVD for advanced Hodgkin’s disease

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In patients with advanced Hodgkin’s disease, increased-dose BEACOPP chemotherapy is associated with better tumor control and overall survival than COPP-ABVD, according to a report published in the June 12th issue of The New England Journal of Medicine.

Findings from another study in the same issue indicate that involved-field radiotherapy does not improve survival in patients with advanced disease who achieve a complete response with chemotherapy.Increased dose “BEACOPP may represent the first real improvement in 10 years in an approach involving chemotherapy as the initial treatment for patients with advanced disease,” Dr. Vincent T. DeVita, from Yale University in New Haven, Connecticut, notes in a related editorial.The standard chemotherapy for advanced Hodgkin’s disease includes mechlorethamine, vincristine, procarbazine, prednisone (MOPP), combined with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Still, the MOPP-ABVD regimen is associated with relapse rates between 30% and 40%.In the first study, Dr. Volker Diehl, from the University of Cologne in Germany, and colleagues tested a regimen similar to MOPP-ABVD (with cyclophosphamide substituted for mechlorethamine) against a high-dose and low-dose regimen of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone (BEACOPP).The study involved 1195 patients with stage IIB, IIIA, IIIB or IV disease who were randomized to receive eight cycles of COPP alternating with ABVD, eight cycles of standard-dose BEACOPP, or eight cycles of increased-dose BEACOPP.At 5-year follow-up, 87% of patients in the increased-dose BEACOPP group had not experienced a treatment failure. This rate was significantly higher than the 69% and 76% rates reported in the COPP-ABVD and standard-dose BEACOPP groups, respectively.Overall survival was also better in the increased-dose BEACOPP group. The five-year survival rates in the COPP-ABVD, standard-dose and increased-dose BEACOPP groups were 83%, 88%, and 91%, respectively. Adverse hematological effects were more common with increased-dose BEACOPP than with the other regimens, but such events were usually manageable. Fatal acute treatment-related effects were equally rare in each of the groups.In the second study, Dr. Berthe M. P. Aleman, from the Netherlands Cancer Institute in Amsterdam, and colleagues assessed the effects of involved-field radiotherapy in 333 patients with advanced Hodgkin’s disease who achieved complete remission with MOPP-ABV. The patients were randomized to undergo radiotherapy or receive no further therapy.Previous studies have yielded conflicting results regarding the benefits of involved-filed radiotherapy, Dr. Aleman’s group notes. In fact, there has been concern that such therapy may increase the risk of late complications, such as second cancers and cardiovascular disease.The radiotherapy group had a 5-year event-free survival rate of 79%, not significantly different from the 84% rate seen in the control group. The corresponding overall survival rates were also not significantly different, at 91% and 85%.In a non-randomized substudy, radiotherapy was given to 250 patients who achieved only a partial response with chemotherapy. The 5-year event-free and overall survival rates in this group were 79% and 87%, respectively, which was comparable to that of patients in complete remission, but better than that usually seen in partial responders.Dr. DeVita notes that about 70% of the patients in the first study were treated with radiotherapy, which greatly increased the risk of marrow dysplasia and leukemia. The findings from the second study suggest that the already impressive results from the first could have been improved further if radiotherapy had not been used.(Source: N Engl J Med 2003;348:2375-2377,2386-2406: Reuters Health: June 11, 2003: Oncolink)


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Posted On: 12 June, 2003
Modified On: 3 December, 2013

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