# PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group

Source: https://onco.cc/key-papers/paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017/  
OnCo record `paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

People whose scan cleared after two rounds of the most intensive Hodgkin regimen could stop after four rounds instead of six or eight, halving severe infections with no loss of control.

## Summary

An open-label, randomised, parallel-group phase 3 trial recruiting patients aged 18 to 60 with newly diagnosed advanced-stage Hodgkin's lymphoma at 301 hospitals and practices in Germany, Switzerland, Austria, the Netherlands and the Czech Republic. After central review of the scan following two cycles of escalated BEACOPP, scan-positive patients were randomised between six further cycles of escalated BEACOPP and the same with rituximab, and scan-negative patients between six further cycles and two further cycles. A 2011 amendment reduced the standard to six cycles in total.

Between 14 May 2008 and 18 July 2014, 2,101 patients were recruited, 137 found ineligible before randomisation and 19 after. Among 434 randomised scan-positive patients, five-year progression-free survival was 89.7 per cent (95 per cent confidence interval 85.4 to 94.0) with escalated BEACOPP and 88.1 per cent (83.5 to 92.7) with rituximab added (log-rank p = 0.46). Among scan-negative patients, five-year progression-free survival was 90.8 per cent (87.9 to 93.7) with eight or six cycles and 92.2 per cent (89.4 to 95.0) with four (difference 1.4 per cent, minus 2.7 to 5.4). Four cycles caused fewer severe infections (40 of 498, 8 per cent, against 75 of 502, 15 per cent) and fewer organ toxicities (38 of 498, 8 per cent, against 91 of 502, 18 per cent).

## Fields

- Kind: Key paper
- Last checked: 2026-10-01
- Also known as: HD18; Borchmann 2017
- Tags: lymphoma-evidence
- Journal: Lancet
- Year: 2017
- DOI: 10.1016/S0140-6736(17)32134-7
- Authors: Borchmann P, Goergen H, Kobe C, et al.
- Findings: Among scan-negative patients, five-year progression-free survival was 92.2 per cent with four cycles of escalated BEACOPP and 90.8 per cent with six or eight (difference 1.4 percentage points, 95 per cent confidence interval minus 2.7 to 5.4).; Four cycles caused severe infections in 8 per cent against 15 per cent, and organ toxicities in 8 per cent against 18 per cent.; Adding rituximab to escalated BEACOPP in scan-positive patients did not improve five-year progression-free survival (89.7 against 88.1 per cent, log-rank p = 0.46).; Ten treatment-related deaths occurred across the trial.; 2,101 patients were recruited; 156 were found ineligible before or after randomisation.
- What it means: The basis for four cycles of escalated BEACOPP as the German standard when the interim scan is negative, and the reason rituximab was abandoned as an addition to that regimen. The authors recommend the scan-guided strategy for all patients with advanced-stage disease.
- Caveats: A protocol amendment mid-trial changed the standard arm from eight cycles to six, so the comparator is not uniform across the recruitment period.; Escalated BEACOPP is not the standard in North America or the United Kingdom, where ABVD-based and brentuximab or nivolumab-based regimens are used, so the de-escalation question looks different there.; Primary analyses in the scan-negative cohort were per protocol.

## Sources

- Lancet 2017: https://doi.org/10.1016/S0140-6736(17)32134-7
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29061295/
- Europe PMC: https://europepmc.org/article/MED/29061295

## Connected records

- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Imaging](https://onco.cc/fronts/imaging/)
- technologies: [PET/CT](https://onco.cc/technologies/pet-ct/)
- drugs: [Bleomycin](https://onco.cc/drugs/bleomycin/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Prednisone](https://onco.cc/drugs/prednisone/), [Procarbazine](https://onco.cc/drugs/procarbazine/), [Rituximab](https://onco.cc/drugs/rituximab/), [Vincristine](https://onco.cc/drugs/vincristine/)
- companies: [German Hodgkin Study Group](https://onco.cc/companies/ghsg/)
- terms: [ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)](https://onco.cc/terms/abvd-beacopp/), [Deauville five-point scale](https://onco.cc/terms/deauville-score/), [Non-inferiority trial](https://onco.cc/terms/non-inferiority/)
- trials: [GHSG HD18](https://onco.cc/trials/hd18/), [GHSG HD21](https://onco.cc/trials/hd21/)
- people: [Andreas Engert](https://onco.cc/people/andreas-engert/), [Peter Borchmann](https://onco.cc/people/peter-borchmann/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)
- key papers: [GHSG HD21: PET-guided BrECADD versus escalated BEACOPP in advanced-stage classical Hodgkin lymphoma](https://onco.cc/key-papers/paper-ghsg-hd21-brecadd-vs-ebeacopp-advanced-hodgkin-lancet-2024/), [RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma](https://onco.cc/key-papers/paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016/)

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