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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.
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).
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.
For fit younger patients treated in the intensive German tradition, BrECADD replaces escalated BEACOPP; how it compares with nivolumab-AVD from S1826 is the open question.
An interim PET scan after two cycles guides treatment of advanced Hodgkin lymphoma: drop bleomycin if negative, intensify if positive.
Shares RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma, Deauville five-point scale, GHSG HD18, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens) and the tag lymphoma-evidence.
Shares GHSG HD21, Deauville five-point scale, GHSG HD18, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens) and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Non-inferiority trial, Procarbazine and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Non-inferiority trial, Procarbazine and the tag lymphoma-evidence.
Shares Andreas Engert, Peter Borchmann, German Hodgkin Study Group, GHSG HD21 and the tag lymphoma-evidence.
Shares Andreas Engert, Peter Borchmann, German Hodgkin Study Group, Deauville five-point scale and the tag lymphoma-evidence.
Shares Andreas Engert, Peter Borchmann, German Hodgkin Study Group, Deauville five-point scale and the tag lymphoma-evidence.
Shares Non-inferiority trial, Survivorship and late effects are neglected, Prednisone, Vincristine and the tag lymphoma-evidence.