GHSG HD21: PET-guided BrECADD versus escalated BEACOPP in advanced-stage classical Hodgkin lymphoma
A new regimen built around brentuximab vedotin cured more patients with advanced Hodgkin lymphoma than the intensive BEACOPP standard, and did so with less toxicity, including less damage to fertility.
Overview
International randomised phase 3 trial of 1,500 patients with newly diagnosed advanced-stage classical Hodgkin lymphoma comparing PET-guided BrECADD (brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone) with PET-guided escalated BEACOPP, four or six cycles depending on interim PET.
Four-year progression-free survival was 94.3 percent with BrECADD against 90.9 percent with escalated BEACOPP, and treatment-related morbidity was lower (about 42 versus 59 percent), with faster recovery of gonadal function. BrECADD is now the GHSG standard for advanced disease.
- Four-year progression-free survival 94.3 percent with BrECADD versus 90.9 percent with escalated BEACOPP.
- Treatment-related morbidity about 42 versus 59 percent, with better recovery of gonadal function.
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.
- Patients were mostly under 60 and fit enough for intensive therapy.
- Follow-up for late effects such as second cancers is still short.
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