Escalated BEACOPP May Improve Prognosis for Advanced-Stage Hodgkin's

According to research appearing in the Journal of Clinical Oncology and carried out by researchers at Universitatsklinik Koln in Germany, a new escalated-dose chemotherapy regimen "improves long-term freedom from treatment failure and overall survival in patients with advanced-stage Hodgkin's disease."

The German Hodgkin Study Group—which has been pushing the BEACOPP regimen for many years—looked at 10-year follow-up results from a previous trial, which compared 2 different doses (baseline and escalated) of the BEACOPP regimen in almost 1200 patients diagnosed with advanced-stage Hodgkin's lymphoma.

In general the BEACOPP regimen contains:
Bleomycin
Etoposide
Doxorubicin
Cyclophosphamide
Vincristine
Procarbazine
Prednisone

According to the study, escalated BEACOPP saw complete remission in 96% of patients versus 88% in baseline BEACOPP. The authors claim that the escalated BEACOPP regimen was also superior to both the COPP and ABVD regimens long considered standard treatment in HL.

While complete remission rates are reportedly higher, the authors note that there is "more acute hematologic toxicity (leukopenia, thrombocytopenia, and anemia) and more grade 3/4 infections" than in BEACOPP baseline.

Furthermore, the escalated regimen is "somewhat more toxic compared to ABVD … However, with adequate management (i.e., growth factors, prophylactic antibiotics) and adaptation of the dose level given to patients' individual tolerability, this regimen is safe also in the outpatient setting."

The researchers are arguing that this new escalated regiment should become the standard of care for advanced HL patients.

Some of the problems associated with BEACOPP are the presence of Procarbazine—which renders just about every patient sterile or infertile—as well as long-term cardiopulmonary toxicity caused by bleomycin and doxorubicin.

More information on the efficacy of the escalated BEACOPP can be found here.

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