Less Intensive Hodgkin’s Chemo Works Better

Fewer cycles of an intensive chemotherapy regimen for advanced Hodgkin’s lymphoma improves outcomes and reduces toxicity, researchers found.

Treatment failure over 5 years actually occurred less often with six cycles of the dose-escalated regimen known as BEACOPP than with the usual eight cycles (89.3% versus 84.4%, 97.5% CI 0.5 to 9.3), according to Andreas Engert, MD, of the University Hospital of Cologne, Germany, and colleagues.

Five-year overall survival also came in significantly higher with the six-cycle escalated BEACOPP arm of the randomized controlled trial (95.3% versus 91.9%), they reported online in The Lancet.

Likewise, the six-cycle regimen was associated with fewer treatment-related events (0.8% versus 2.1%) and fewer secondary malignancies (0.7% versus 1.8%) than the eight-cycle regimen.

That regimen “should be the treatment of choice for advanced stage Hodgkin’s lymphoma,” Engert’s group concluded.

The researchers speculated that these findings may boost use of the regimen, which, although previously shown more effective for failure-free survival, hasn’t overtaken the ABVD regimen typically used in the United States.

Most centers outside of the German study group that came up with the escalated regimen have been reluctant to use it in routine practice for a few reasons, noted Olivier Casasnovas, MD, of Hôpital le Bocage in Dijon, France, and Bertrand Coiffier, MD, PhD, of University Lyon, France.

Hodgkin’s lymphoma - formerly known as Hodgkin’s disease - is a cancer of the lymphatic system, which is part of your immune system.

In Hodgkin’s lymphoma, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin’s lymphoma progresses, it compromises your body’s ability to fight infection.

Hodgkin’s lymphoma is one of two common types of cancers of the lymphatic system. The other type, non-Hodgkin’s lymphoma, is far more common.

Advances in diagnosis and treatment of Hodgkin’s lymphoma have helped to give people with this diagnosis the chance for a full recovery. The prognosis continues to improve for people with Hodgkin’s lymphoma.

Escalated BEACOPP has a higher rate of immediate hematologic toxicity requiring adapted and costly clinical management, results in infertility for many young women, and hasn’t translated into improved overall survival compared with ABVD, they explained in an accompanying commentary.

The less intensive version of escalated BEACOPP is an important step toward balancing efficacy and toxicity, Casasnovas and Coiffier argued.

“The dose intensity of escalated BEACOPP is crucial for disease control, but eight cycles of escalated BEACOPP overtreat a large proportion of patients, leading to an excess of therapy-related death,” they wrote.

Symptoms of Hodgkin lymphoma

The first symptom of Hodgkin lymphoma is usually a swelling in the neck, armpit or groin. The swellings are usually painless, but some people may find that they ache.

Other symptoms may include any of the following:

drenching and/or frequent sweats, especially at night
unexplained high temperatures
weight loss
a cough or breathlessness
a persistent itch all over the body.

The most common symptoms are high temperatures, drenching night sweats and weight loss. These are known as B symptoms. Other symptoms will depend on where in the body the enlarged lymph nodes are.

The escalated BEACOPP regimen includes bleomycin (Blenoxane), etoposide (Etopophos, Vepesid), doxorubicin (Adriamycin, Rubex), cyclophosphamide (Cytoxan), vincristine (Oncovin, Vincasar), procarbazine (Matulane), and prednisone; whereas ABVD consists of doxorubicin, bleomycin, vinblastine (Velban), and dacarbazine (Dtic-Dome).

The HD15 study included 2,182 patients with newly diagnosed advanced stage Hodgkin’s lymphoma ages 18 to 60 and randomly assigned to six or eight cycles of escalated BEACOPP given every 3 weeks, or eight cycles of BEACOPP given every two weeks. Patients got radiotherapy depending on residual tumor activity on PET scan.

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