Skip to main content
SpringerLink
Log in

Which Hodgkin’s Patients in the Unites States Should Be Treated with BEACOPP?

  • Lymphomas (J Armitage, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

The majority of patients with advanced Hodgkin lymphoma are cured with current standard therapy such as Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD). However, almost 20 % of patients fail to achieve complete remission, and depending upon risk group, 20–30 % experience relapse with prolonged follow-up. BEACOPP (bleomycin, etoposide, Adriamycin, cyclophosphamide, prednisone, procarbazine) was developed by the German Hodgkin Study Group (GHSG) to improve upon standard therapy by intensifying treatment and substituting etoposide and procarbazine for vinblastine and dacarbazine, respectively. In the HD9 trial, escalated BEACOPP was shown to be superior to COPP/ABVD with regard to time to treatment failure, but was associated with increased risk of secondary malignancies. Modifications of BEACOPP were developed to maintain efficacy while reducing the adverse effects. While several randomized trials have confirmed prolongation of progression-free survival with BEACOPP compared to ABVD, a survival advantage has been difficult to demonstrate. Given the comparable survival between BEACOPP and ABVD, as well as the greater toxicities of the former, including infertility, myelosuppression, and secondary malignancies, ABVD should remain the standard regimen for patients in the U.S. Newer regimens incorporating novel agents such as brentuximab vedotin may further improve the efficacy of current regimens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. DeVita Jr VT, Serpick AA. Combination chemotherapy in the treatment of advanced Hodgkin's disease. Ann Intern Med. 1970;73:881–95.

    Article  PubMed  Google Scholar 

  2. DeVita Jr VT, Simon RM, Hubbard SM, et al. Curability of advanced Hodgkin's disease with chemotherapy. Long-term follow-up of MOPP-treated patients at the National Cancer Institute. Ann Intern Med. 1980;92:587–95.

    Article  PubMed  Google Scholar 

  3. Santoro A, Bonadonna G, Bonfante V, et al. Alternating drug combinations in the treatment of advanced Hodgkin's disease. N Engl J Med. 1982;306:770–5.

    Article  PubMed  CAS  Google Scholar 

  4. Bonadonna G, Zucali R, Monfardini S, et al. Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer. 1975;36:252–9.

    Article  PubMed  CAS  Google Scholar 

  5. Canellos GP, Anderson JR, Propert KJ, et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 1992;327:1478–84.

    Article  PubMed  CAS  Google Scholar 

  6. Duggan DB, Petroni GR, Johnson JL, et al. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin's disease: report of an intergroup trial. J Clin Oncol. 2003;21:607–14.

    Article  PubMed  CAS  Google Scholar 

  7. Diehl V, Sieber M, Rüffer U, et al. BEACOPP: an intensified chemotherapy regimen in advanced Hodgkin's disease. Ann Oncol. 1997;8:143–8.

    Article  PubMed  CAS  Google Scholar 

  8. Tesch H, Diehl V, Lathan B, et al. Moderate dose escalation for advanced stage Hodgkin's disease using the bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone scheme and adjuvant radiotherapy: a study of the German Hodgkin's Lymphoma Study Group. Blood. 1998;92:4560–7.

    PubMed  CAS  Google Scholar 

  9. Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med. 2003;348:2386–95.

    Article  PubMed  CAS  Google Scholar 

  10. Sieber M, Bredenfield H, Josting A, et al. 14-day variant of the bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone regimen in advanced-stage Hodgkin's lymphoma: results of a pilot study of the German Hodgkin's Lymphoma Study Group. J Clin Oncol. 2003;21:1734–9.

    Article  PubMed  CAS  Google Scholar 

  11. Engert A, Bredenfield H, Döhner H, et al. Pegfilgrastim support for full delivery of BEACOPP-14 chemotherapy for patients with high-risk Hodgkin's lymphoma: results of a phase II study. Haematologica. 2006;91:546–9.

    PubMed  CAS  Google Scholar 

  12. Borchmann P, Haverkamp H, Diehl V, et al. Eight cycles of esdalated-dose BEACOPP compared with four cycles of escalalated-dose BEACOPP followed by four cycles of baseline-dose BEACOPP with or without radiotherapy in patients with advanced-stage Hodgkin's lymphomaL final analysis of the HD12 trial of the German Hodgkin Study Group. J Clin Oncol. 2011;29:423404242.

    Article  Google Scholar 

  13. Santoro A, Devizzi L, Bonfante V, et al: Phase II study with gemcitabine in pretreated patients with Hodgkin's (HD) and non-Hodgkin's lymphomas (NHL): results of a multicenter study. Proc ASCO 16:21a (abstr 71), 1997

  14. Tesch H, Santoro A, Fiedler F, et al: Phase II study of gemcitabine in pretreated Hodgkin's disease: results of a multicenter study. Blood 90:339a (abstr 1514), 1997

  15. Bredenfield H, Franklin J, Nogova L, et al. Severe pulmonary toxicity in patients with advanced-stage Hodgkin's disease treated with a modified bleomycin, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone, and gemcitabine (BEACOPP) regimen is probably related to the combination of gemcitabine and bleomycin : a report of the Gerrman Hodgkin's Lymphoma Study Group. J Clin Oncol. 2004;22:2424–9.

    Article  Google Scholar 

  16. Engert A, Haverkamp H, Kobe C, et al. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet. 2012;379:1791–9.

    Article  PubMed  CAS  Google Scholar 

  17. Engert A, Plutschow A, Eich HT, et al. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med. 2010;363:640–52.

    Article  PubMed  CAS  Google Scholar 

  18. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin's disease. N Engl J Med. 1998;339:1506–14.

    Article  PubMed  CAS  Google Scholar 

  19. Ballova V, Rüffer J-U, Haverkamp H, et al. A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin's disease comparing BEACOPP baseline and COPP-ABVD (study HD9elderly). Ann Oncol. 2005;16:124–31.

    Article  PubMed  CAS  Google Scholar 

  20. Hartmann P, Rehwald U, Salzberger B, et al. BEACOPP therapeutic regimen for patients with Hodgkin's disease and HIV infection. Ann Oncol. 2003;14:1562–9.

    Article  PubMed  CAS  Google Scholar 

  21. Behringer K, Josting A, Schiller P, et al. Solid tumors in patients treated for Hodgkin's disease: a report from the German Hodgkin Lymphoma Study Group. Ann Oncol. 2004;15:1079–85.

    Article  PubMed  CAS  Google Scholar 

  22. Josting A, Wiedenmann S, Franklin J, et al. Secondary myeloid leukemia and myelodysplastic syndromes in patients treated for Hodgkin's disease: a report from the German Hodgkin's Lymphoma Study Group. J Clin Oncol. 2003;21:3440–6.

    Article  PubMed  Google Scholar 

  23. Behringer K, Mueller H, Georgen H, et al. Gonadal function and fertility in survivors after Hodgkin lymphoma treatment within the German Hodgkin Study Group HD13 to HD15 trials. J Clin Oncol. 2013;31:231–9.

    Article  PubMed  CAS  Google Scholar 

  24. Skoetz N, Trelle S, Rancea M, et al. Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis. Lancet Oncol. 2013;14:943–52.

    Article  PubMed  Google Scholar 

  25. Federico M, Bellei M, Cheson BD. BEACOPP or no BEACOPP? Lancet Oncol. 2013;14:e487–8.

    Article  PubMed  Google Scholar 

  26. Moccia AA, Donaldson J, Chhanabhai M, et al. International prognostic score in advanced-stage Hodgkin's lymphoma: altered utility in the modern era. J Clin Oncol. 2012;30:3383–8.

    Article  PubMed  Google Scholar 

  27. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25:579–86.

    Article  PubMed  Google Scholar 

  28. Federico M, Luminari S, Iannitto E, et al. ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin's lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi trial. J Clin Oncol. 2009;27:805–11.

    Article  PubMed  Google Scholar 

  29. Viviani S, Zinzani PL, Brusamolino E, et al. ABVD versus BEACOPP for Hodgkin's lymphoma when high-dose salvage is planned. N Engl J Med. 2011;365:203–12.

    Article  PubMed  CAS  Google Scholar 

  30. Carde PP, Karrasch M, Fortpied C, et al: ABVD (8 cycles) versus BEACOPP (4 escalated= > 4 baseline) in stage III-IV high-risk Hodgkin lymphoma (HL): first results of EORTC 20012 intergroup randomized phase III clinical trial. J Clin Oncol 30:abstract # 8002, 2012

  31. Dann EJ, Bar-Shalom R, Tamir A, et al. Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome. Blood. 2007;109:905–9.

    Article  PubMed  CAS  Google Scholar 

  32. Gallamini A, Patte C, Viviani S, et al. Early chemotherapy intensification with BEACOPP in advanced-stage Hodgkin lymphoma patients with an int4erim-PET positive after two ABVD courses. Br J Haematol. 2011;152:551–60.

    Article  PubMed  Google Scholar 

  33. Press OW, Li H, Schoder H, et al: Response adapted therapy of stage III-IV Hodgkin lymphoma based on interim FDG-PET imaging: early results of US Intergroup S0816. Haematologica 90:36 (abstract T108), 2013

  34. Johnson P, Federico M, Fossa A, et al: Response rates and toxicity of response-adapted therapy in advanced Hodgkin lymphoma: initial results from the internationla RATHL study. Haematologica 98:2 (abstract# T003, 2013

  35. Younes A, Gopal AK, Smith SE, et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol. 2012;30:2183–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  36. Younes A, Connors JM, Park SI, et al. Frontline therapy with brentuximab vedotin combined with ABVD or AVD in patients with newly diagnosed advanced stage Hodgkin lymphoma. Blood. 2011;118:436–7.

    Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Dr. Bruce Cheson declares no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, USA

    Bruce D. Cheson

Authors
  1. Bruce D. Cheson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bruce D. Cheson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheson, B.D. Which Hodgkin’s Patients in the Unites States Should Be Treated with BEACOPP?. Curr Hematol Malig Rep 9, 222–226 (2014). https://doi.org/10.1007/s11899-014-0213-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-014-0213-6

Keywords

Search

Navigation