According to results of a randomized trial, conducted by Dr. Andreas Engert, University Hospital of Cologne, Germany, and his team, lower doses of chemotherapy can treat individuals with advanced Hodgkin’s lymphoma (a cancer affecting lymph tissue) more effectively. The study is published Online First by The Lancet.

The researchers randomly assigned participants to receive either 8 cycles of a standard regimen with radiotherapy or 6 cycles in addition to radiotherapy.

BEACOPP 14, the “baseline” dose of drugs, is administered every two weeks whilst BEACOPP escalated, the higher dose of various drugs, is administered in 3-week intervals.

The researchers set out to determine whether 6 cycles of treatment (6xBEACOPP escalated) was more effective at reducing toxicity of chemotherapy than “the old standard” of 8 cycles of treatment (8xBEACOPP 14) given at shorter time intervals.

2,126 of the 2,182 study participants were included in the intention-to-treat analysis set. The authors randomly assigned 705 participants to received 8xBEACOPP esc., 710 participants to receive 8xBEACOPP 14, and 711 patients to 6xBEACOPP esc.

They found that freedom from treatment failure was sequentially non-inferior for the 6xBEACOPP esc and 8xBEACOPP 14 groups than with 8xBEACOPP esc.

For participants in the 8xBEACOPP esc. group, 5-year freedom from treatment rates were 84%, 89% for patients in the 6xBEACOPP esc. group, and 85% for those in the 8xBEACOPP 14 group.

In addition, the investigators found that overall survival was 92% in the 8xBEACOPP esc. group, 95% in the 6xBEACOPP esc. group, and 95% in the 8xBEACOPP 14 group. Overall survival was considerably better among participants receiving 6xBEACOPP esc. than those receiving 8xBEACOPP esc.

Mortality rates were higher among the 8xBEACOPP esc. group (8%) than the 6xBEACOPP esc. group (5%) and the 8xBEACOPP 14 group (5%). According to the researchers, the difference in mortality rates is primarily due to treatment-related events and secondary cancers.

The authors explained:

“Treatment with six cycles of BEACOPP escalated followed by PET-guided radiotherapy was more effective in terms of freedom from treatment failure and less toxic than eight cycles of the same chemotherapy regimen.

Thus, six cycles of BEACOPP escalated should be the treatment of choice for advanced stage Hodgkin’s lymphoma. PET done after chemotherapy can guide the need for additional radiotherapy in this setting.

In the HD15 study presented here, we found better overall survival, superior tumor control, and less toxicity with 6 cycles of BEACOPP escalated as compared with eight cycles for treatment of advanced stage Hodgkin’s lymphoma.

Since the data presented here were generated by a large number of contributing centers from all levels of care, the results of HD15 should help reducing barriers against the use of this effective treatment in advanced stage Hodgkin lymphoma.”

In a joint comment, Dr. Olivier Casasnovas, Hôpital le Bocage, Dijon, France, and Dr Bertrand Coiffier, Centre Hospitalier Lyon-Sud, France, said:

“Although an important step has been reached towards improvement of the balance of efficacy and toxicity with the upfront BEACOPP escalated regimen in patients with advanced Hodgkin’s lymphoma, the future will require additional efforts to identify patients needing fewer than six cycles of BEACOPP escalated.”

Written by Grace Rattue