{"entity":{"id":"hd18","kind":"trial","name":"GHSG HD18","aka":["HD18","Positron emission tomography-guided escalated BEACOPP"],"tldr":"People whose scan was clear after two rounds of the most intensive Hodgkin chemotherapy could stop after four rounds instead of six or eight, with the same disease control and far fewer severe infections.","summary":"Escalated BEACOPP controls advanced Hodgkin lymphoma better than ABVD and costs more in infections, organ damage, second leukaemias and infertility. HD18 asked whether the scan after two cycles could be used to give more to the people who need it and less to those who do not. 2,101 patients aged 18 to 60 were recruited at 301 sites in Germany, Switzerland, Austria, the Netherlands and the Czech Republic, and randomised by their scan result.\n\nIn the scan-positive cohort, adding rituximab to escalated BEACOPP changed nothing: five-year progression-free survival 89.7 per cent (95 per cent confidence interval 85.4 to 94.0) with escalated BEACOPP against 88.1 per cent (83.5 to 92.7) with rituximab added (log-rank p = 0.46). In the scan-negative cohort, four cycles were non-inferior to six or eight: 92.2 per cent (89.4 to 95.0) against 90.8 per cent (87.9 to 93.7), a difference of 1.4 points (minus 2.7 to 5.4). Four cycles caused fewer severe infections (8 against 15 per cent) and fewer organ toxicities (8 against 18 per cent).\n\nThe scan-positive result is worth stating as a failure: rituximab added nothing to an already intensive regimen and the field stopped pursuing it. The scan-negative result is why four cycles became the German standard, and why HD21 could then go further and replace the bleomycin, vincristine and procarbazine of escalated BEACOPP with brentuximab vedotin and dacarbazine.","status":"positive","asOf":"2026-10-01","links":[{"label":"ClinicalTrials.gov NCT00515554","url":"https://clinicaltrials.gov/study/NCT00515554"},{"label":"Lancet 2017","url":"https://doi.org/10.1016/S0140-6736(17)32134-7"}],"tags":["lymphoma-evidence"],"related":[],"cancers":["advanced-stage-classical-hodgkin-lymphoma","hodgkin-lymphoma"],"sections":["chemotherapy","imaging"],"technologies":["pet-ct","cytotoxic-chemotherapy"],"targets":[],"drugs":["bleomycin","etoposide","doxorubicin","cyclophosphamide","vincristine","procarbazine","prednisone","rituximab"],"companies":["ghsg"],"institutions":[],"pathways":[],"terms":["deauville-score","abvd-beacopp","non-inferiority"],"trials":["hd21","ahl2011"],"people":["peter-borchmann","andreas-engert"],"bottlenecks":["b-toxicity-qol","b-survivorship"],"keyPapers":["paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT00515554","phase":"3","setting":"Aged 18 to 60 with newly diagnosed advanced-stage Hodgkin lymphoma: treatment intensity set by the scan after two cycles of escalated BEACOPP","sponsor":"University of Cologne (German Hodgkin Study Group)","result":"Four cycles of escalated BEACOPP non-inferior to six or eight after a negative scan (five-year progression-free survival 92.2 against 90.8 per cent) with half the severe infections; adding rituximab to a positive scan arm did nothing.","started":"2008-05","startedType":"actual","yearReported":2017,"enrolled":1945,"enrolledBasis":"randomised","enrolledNote":"The registry target was 1,500; 2,101 patients were recruited, 156 were found ineligible, and 1,945 were randomised across the two scan-defined cohorts in the Lancet report.","outcomes":[{"endpoint":"Progression-free survival at 5 years, scan-negative cohort","primary":true,"unit":"%","arms":[{"name":"Four cycles of escalated BEACOPP","n":501,"value":92.2,"note":"95 per cent confidence interval 89.4 to 95.0"},{"name":"Six or eight cycles of escalated BEACOPP","n":504,"value":90.8,"note":"87.9 to 93.7"}],"source":"https://doi.org/10.1016/S0140-6736(17)32134-7"},{"endpoint":"Progression-free survival at 5 years, scan-positive cohort","unit":"%","arms":[{"name":"Escalated BEACOPP","n":217,"value":89.7},{"name":"Escalated BEACOPP with rituximab","n":217,"value":88.1}],"p":"0.46"},{"endpoint":"Severe infections, scan-negative cohort","unit":"%","arms":[{"name":"Four cycles of escalated BEACOPP","n":498,"value":8},{"name":"Six or eight cycles of escalated BEACOPP","n":502,"value":15}]}],"replication":"The same de-escalation logic as AHL2011, which reached a similar conclusion by switching to ABVD instead of stopping early."},"route":"/trials/hd18/","neighbours":{"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"prednisone","kind":"drug","name":"Prednisone","route":"/drugs/prednisone/"},{"id":"procarbazine","kind":"drug","name":"Procarbazine","route":"/drugs/procarbazine/"},{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"company":[{"id":"ghsg","kind":"company","name":"German Hodgkin Study Group","route":"/companies/ghsg/"}],"term":[{"id":"abvd-beacopp","kind":"term","name":"ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)","route":"/terms/abvd-beacopp/"},{"id":"deauville-score","kind":"term","name":"Deauville five-point scale","route":"/terms/deauville-score/"},{"id":"non-inferiority","kind":"term","name":"Non-inferiority trial","route":"/terms/non-inferiority/"}],"trial":[{"id":"ahl2011","kind":"trial","name":"AHL2011","route":"/trials/ahl2011/"},{"id":"hd21","kind":"trial","name":"GHSG HD21","route":"/trials/hd21/"},{"id":"rathl","kind":"trial","name":"RATHL","route":"/trials/rathl/"}],"person":[{"id":"andreas-engert","kind":"person","name":"Andreas Engert","route":"/people/andreas-engert/"},{"id":"peter-borchmann","kind":"person","name":"Peter Borchmann","route":"/people/peter-borchmann/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"paper":[{"id":"paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019","kind":"paper","name":"PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study","route":"/key-papers/paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019/"},{"id":"paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017","kind":"paper","name":"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","route":"/key-papers/paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017/"}],"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/lymphoma-roadmap/"}]}}