by ecancer reporter Janet Fricker

Intensifying treatment for patients with early unfavourable Hodgkin Lymphoma (HL) resulted in significant improvements in tumour control, concluded a study from the German Hodgkin Study Group presented at the American Society of Hematology (ASH) Annual meeting and Exposition held December 4-7, 2010, Orlando, Florida.

HL can be divided into three categories, early favourable, early unfavourable and advanced disease. For early unfavourable HL the long term control rate is around 85 % at five years. In order to improve overall survival and freedom from treatment failure, researchers from the German Hodgkin Study Group initiated the HD14 trial to determine whether an escalated dose of BEACOPP chemotherapy (cyclophosphamide, doxorubicin, etopodise, procarbazine, prednisone, bleomycin, and vincristine) improved freedom from treatment failure in patients with early unfavourable HL when added to standard ABVD chemotherapy.

In the HD14 study, between January 2003 and July 2008 1,655 patients with early, unfavourable HL from 350 centres in Europe, were randomised to receive four cycles of ABVD chemotherapy (the control arm, n=818), or to receive two cycles of an escalated dose of BEACOPP chemotherapy followed by two cycles of ABVD chemotherapy (n=805). All patients received 30 Gy IF-RT.

Results at a median follow-up of 42.4 months, show that the four year freedom from treatment failure rate was 94.7 % in the BEACOPP/ABVD arm versus 89.3% in the ABVD control arm (p=0.0001) The overall response rate to treatment was 95% for each arm of the study, with no significant difference in overall survival seen yet (P=0.95). Acute grade III-IV toxicity rates of chemotherapy were 81.1% in the BEACOPP/ ABVD arm versus 50.7% in the control arm; with leucopenia rates of 79% versus 24%, hair loss of 48% versus 24 %, thrombocytopenia of 22 % versus 0.1% and anaemia of 9% versus 1%.

"Results from this study demonstrate that an early intensification treatment approach with an escalated regimen of BEACOPP chemotherapy results in better overall tumour control in patients with early unfavourable HL," said study presenter Andreas Engert, from University Hospital Cologne (Germany), adding that although toxicity was higher in experimental arm, this did not translate into higher overall mortality.

Commenting on the study, Ginna Laport, the press conference moderator from Stanford University Medical Center (Stanford, California, US), said, "If any study will change the standard of care this one will, with the caveat is that there was no difference in overall survival between the two groups."

Reference

A Engert, P Borchmann, A Pluetschow, et al. Dose-escalation with BEACOPP escalated is superior to ABVD in the combined modality treatment of early unfavourable Hodgkin lymphoma: final analysis of the German Hodgkin study group (GHSG) HD14 trial. Abstract number 765, ASH 2010.