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Which is a better treatment option – ABVD or BEACOPP?

The long-term results of the HD2000 trial comparing ABVD to BEACOPP in untreated patients with Hodgkin Lymphoma were published in a previous edition of the Journal of Clinical Oncology by Merli F. et al. on behalf of the FIL (Fondazione Italiana Linfomi)1. They reported a 10-year follow-up analysis of the trial comparing six cycles of ABVD, four cycles of e-BEACOPP followed by two cycles of s-BEACOPP and six cycles of CEC. Although there was no statistical difference in PFS between the 3 regimens, there was a positive trend for BEACOPP, which didn’t translate into OS advantage. The authors reported a significantly higher rate of secondary malignancies after BEACOPP, which might explain these OS results, although the trial was not designed to show any OS advantage for one of the regimens. The authors concluded that BEACOPP might be an option, whereas ABVD + limited RT remains the standard of care.

In a recent correspondence2 to the Journal of Clinical Oncology, Vassilakopoulos T. P. from the National and Kapodistrian University of Athens and Johnson P. W. M. from the Cancer Research UK Center and Southampton General Hospital, commented this article by highlighting that other trials (LYSA H34, EORTC 20012 Intergroup trial) as well as a network meta-analysis, reported a higher OS (not statistically meaningful) with BEACOPP compared to ABVD. They analyzed deeply the Italian HD2000 results and found that some protocol deviations (9% of patients received ABVD instead of BEACOPP) might have favored ABVD results, and suggested that an as-treated analysis for the therapy delivered might provide other results that those reported with an intention-to-treat analysis.   

The complete article by Merli et al., can be found here.

The letter to the editor by Theodoros P Vassilakopolous and Peter W. M. Johnson can be found here.

References:
  1. Merli F. et al. Long term results of the HD2000 trail comparing ABVD versus BEACOPP versus COPP-EBV-CAD in untreated patients with advanced Hodgkin Lymphoma: A study by Fondazione Italiana Linfomi. J Clin Oncol 2016  Apr 10; 34(11):1175-81. doi: 10.1200/JCO.2015.62.4817. Epub 2015 Dec 28.
  2. Vassilakopoulos T.P. & Johnson P. W.  HD2000 Update in Hodgkin Lymphoma-ABVD or BEACOPP? J Clin Oncol 2016 Aug 15. pii: JCO679431. 679431. Epub ahead of print.