Escalated Beacopdac provides real-world results similar to escalated Beacopp and superior outcomes to response-adjusted ABVD (RATHL), while potentially reducing toxicity compared to escalated Beacopp (2023)

Background:

In the treatment of advanced Hodgkin's lymphoma, it is increasingly common practice in the UK to modify escalated BEACOPP (eBPP) by removing oral procarbazine and replacing it with intravenous dacarbazine (250 mg/m2 D2-3) to reduce hematopoietic stem cell and gonadal toxicity. However, published data on the "escalated BEACOPDac (eBPDac)" regimen are very limited.

Method:

This is a retrospective study of 225 patients from 20 centers in the UK, Ireland and France who were treated with eBPDac first-line for advanced Hodgkin's lymphoma. Toxicity outcomes were compared with 58 matched patients treated with eBPP at 4 UK centers and survival outcomes were compared with 2073 eBPP patients in the HD18 trial1and with 1088 patients aged 18-59 years in the RATHL trial2,3. Most patients with eBPDac were treated according to the HD18 protocol. 34 patients treated in Paris followed the AHL2011 protocol with two cycles of eBPDac given up front and if iPET2 was negative they were de-escalated to 4 cycles of ABVD.

Toxicity outcomes:

Toxicity was compared between eBPDac patients (n=225; median follow-up 22.1 months) and matched real-world UK eBPP patients (n=58; median follow-up 52.7 months) during the first 4 cycles. Patients with eBPP and eBPDac were well matched with no significant differences in age (median 23 years vs 26 years), sex, stage (stage 3/4 82% vs 83%) and international prognostic score (IPS 3+ 74 % compared to 65%) . 55% of patients with eBPDac received only 4 cycles (vs. 12% of patients with eBPP; p<0.001) reflecting published data from the HD18 trial. Mean day 8 (D8) ALT was similar between the two regimens. The mean D8 neutrophil count tended to be lower in eBPDac than in eBPP patients (2.04 vs. 2.45; p=0.072; G-CSF with D9), however, it increased to 6.48 in eBPDac patients who received GCSF from D4. There were fewer non-elective hospital care days for eBPDac compared to eBPP (mean 3.35 vs 5.84; p=0.022), and eBPDac patients received fewer RBC transfusions compared to eBPP patients ( average 1.79 units vs. 4.16 units; p<0.001). Women aged <35 years who completed ≥4 cycles of eBPDac/eBPP had a similar rate of menses returning (eBPP 22/25; eBPDac 41/41), although eBPDac patients appeared to resume menses earlier after chemotherapy (mean 4 .64 months compared to 9.12 months, p=0.0026). However, this may also reflect the higher mean number of chemotherapy cycles completed by women with eBPP (5.86 vs. 4.60; p<0.001). The use of Goserelin to suppress ovulation varied from center to center.

Consequences of the disease:

Patients with eBPDac (n=225) were younger than patients with HD18 (median age 26 years vs. 35 years, p<0.001) and patients with RATHL (median age 26 years vs. 31 years). However, they had a higher risk of disease than HD18 (IPS 4+ 36% vs. 16%, p<0.001) and RATHL patients (IPS 3+ 65% vs. 33%, p<0.001) and more stage 4 disease than HD18 ( 66% vs. 36%, p<0.001) and RATHL (66% vs. 28%, p<0.001). Of the 225 patients starting eBPDac, 77% achieved an iPET2 Deauville score (DS) ≤3, similar to RATHL (DS ≤3: 83.7%) and HD18 (DS ≤3: 76%). Of the patients with eBPDac, one patient had primary refractory disease and ten relapsed between 6 and 36 months. One 56-year-old eBPDac patient with high IPS died of bowel perforation during cycle 1, and one 34-year-old with alcoholic liver disease died 8 months after treatment while still in remission. To date, there have been no lymphoma-related deaths.

Figure 1 shows Kaplan-Meier plots for progression-free survival (PFS) and overall survival (OS). PFS at 22 months (median follow-up) of eBPDac patients was 94.9% (91.7-98.3%), which is similar to the HD18 3-year PFS of 92.3% (91.1-93, 5%) and seems better than the RATHL 5-year PFS of 81.4%. (78.9-83.7%). The difference in PFS between eBPDac and RATHL is most pronounced in patients with IPS3+. OS rates with all 3 regimens are excellent, with a 22-month eBPDac OS estimate of 98.9% (97.4-100%).

Summary/Conclusion:

Acknowledging the limitations of the retrospective study, we suggest that replacing procarbazine with dacarbazine is unlikely to compromise the efficacy of eBPP and may have some advantages in terms of toxicity. Despite a clear preference by clinicians to offer this regimen to high-risk, advanced-stage patients, with a median follow-up of almost 2 years, we observed similar PFS and OS compared to HD18, but superior survival estimates compared to 18-59-year-old RATHL patients, suggesting that eBPDac is very effective in the treatment of Hodgkin's lymphoma.

Reference:

1Borchmann P i on. Lancet 2017; 390: 2790-2802

2Johnson Pi on. BORN. 2016.; 374: 2419-2429

3Russell J i sur. Ann Hematol 2021; 100:1049-1058

Escalated Beacopdac provides real-world results similar to escalated Beacopp and superior outcomes to response-adjusted ABVD (RATHL), while potentially reducing toxicity compared to escalated Beacopp (2)
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Disclosures

Brice:MSD:funding of research;Amgen:Other: Travel/accommodation/expenses;Roche:Other: Travel/accommodation/expenses;Takeda:Research funding.He would go:Dragon/Gilead:Fees, membership on the entity's board of directors or advisory boards, other: travel support, research funding, speakers' bureau;Novartis:Fees, membership on the entity's board of directors or advisory boards, research funding, speakers' bureau;Janssen:Fees, membership on the entity's board of directors or advisory boards, research funding, speakers' bureau;Celgene:Fees, membership in the entity's board of directors or advisory boards, other: travel grants;Amgen:Fees, membership in the entity's board of directors or advisory boards, other: travel grants;Astra Zeneca:funding of research;Jazz:Other: travel grants;Pfizer:Fees, membership in the entity's board of directors or advisory boards, other: travel grants;Bayer:Other: travel grants;Kyowa Kirin:Other: travel grants;Daiichi Sankyo:Fees, membership in the board of directors or advisory boards of the entity;Portal:Fees, membership in the board of directors or advisory boards of the entity;Takeda:Other: Fees for lectures;Roche:Other: Fees for lectures.Osborne:Roche:other;Takeda:other;Pfizer:other;Servier:other;Gilead:other;Novartis:other;MSD:the rest.Ardeshna:Gilead, Beigene, Celegene, Novartis i Roche:Membership in the management board or advisory boards of the entity;Gilead, Beigene, Celegene, Novartis i Roche:Honorari;Norvartis, BMS, Autolus, ADCT, Pharmocyclics i Jansen:Research funding.Collins:Pfizer:Honorari;Amgen:funding of research;AstraZeneca:Fees, research funding;Beige:Membership in the management board or advisory boards of the entity;Novartis:Honorari, Speakers Bureau;Celgene:funding of research;ADC Therapeutics:Fees, membership in the board of directors or advisory boards of the entity;Celleron:Fees, membership in the entity's board of directors or advisory boards, research funding;Merck Sharp & Dohme:Fees, membership in the entity's board of directors or advisory boards, research funding;Bristol Myers Squibb:Fees, membership on the entity's board of directors or advisory boards, research funding, speakers' bureau;Gilead:Fees, membership in the Board of Directors or advisory boards of the subject, Speakers' Bureau;Takeda:Fees, membership in the Board of Directors or advisory boards of the subject, Speakers' Bureau;Roche:Fees, membership on entity's board of directors or advisory boards, other: travel expenses, speakers' bureau.Cwynarski:Adienne, Takeda, Roche, Autolus, KITE, Gilead, Celgene, Atara, Janssenen:the rest.Davies:Janssen:Fees, research funding;Karyopharm Therapeutics:Membership in the entity's board of directors or advisory boards, research funding;Acerta Pharma/AstraZeneca:Fees, research funding;ADC Therapeutics:Fees, research funding;BioInvent:funding of research;Incyte:Membership in the management board or advisory boards of the entity;Dragon:Fees, membership in the entity's board of directors or advisory boards, research funding;Roche:Fees, membership in the entity's board of directors or advisory boards, other: travel to scientific conferences, research funding;Celgene:Fees, membership in the entity's board of directors or advisory boards, other: travel to scientific conferences, research funding.Furtado:Abbvie:Other: Conference support.Gallop-Evans:Takeda:Membership in the management board or advisory boards of the entity;Kyowa-Kirin:Membership in the entity's board of directors or advisory boards.Iyengar:Gilead:Membership in the Board of Directors or advisory boards of the entity, Other: support for conferences, Speakers' Bureau;Takeda:Membership in the Board of Directors or advisory boards of the entity, Other: support for conferences, Speakers' Bureau;Beige:Membership in the management board or advisory boards of the entity;Abbvie:Other: conference support;Janssen:Other: conference support, Speakers Bureau.Linton:Roche:Consulting, Fees, Membership in the Board of Directors or advisory boards of the subject, Funding of research;Aptitude Health:Honorari;Hartley Taylor:Honorari;University of Manchester:Current employment;Celgene:funding of research;BeiGene:funding of research;Genmab:Consulting, membership in the entity's board of directors or advisory boards, research funding.Martinez Street:Abbvie:the rest.McKay:Roche:Fees, membership in the board of directors or advisory boards of the entity;Gilead:Fees, other: travel support;DRAGON:Fees, membership in the board of directors or advisory boards of the entity;Takeda:Fees, membership in the entity's board of directors or advisory boards, other: travel support;Janssen:Fees, other: travel support;Beige:Fees, membership in the board of directors or advisory boards of the entity;BMS/Celgene:Fees, membership in the entity's board of directors or advisory boards.Nagumantriya:Takeda, Alexion, Abbvie:the rest.Chess:Abbvie, Janssen i Roche:Fees, membership in the entity's board of directors or advisory boards.Uttenthal:Jazz:other;Takeda:other;Roche:the rest.McMillan:Pfizer:funding of research;F. Hoffmann-La Roche Ltd:Consulting, Fees, Speakers Bureau;Amgen:Membership in the management board or advisory boards of the entity;Abbie:Membership in the entity's board of directors or advisory boards.Coming up:Janssen, Abvie, Roche, AZ:the rest.

FAQs

What is the difference between escalated BEACOPP and BEACOPP? ›

BEACOPP in baseline dose contains all drug dosages of COPP/ABVD (except vincristine and procarbazine) rearranged in a shorter, 3-week cycle. Escalated BEACOPP uses higher doses of cyclophosphamide, doxorubicin, and etoposide with granulocyte colony-stimulating factor (G-CSF) support.

What is the BEACOPP chemotherapy regimen? ›

An abbreviation for a chemotherapy combination used to treat advanced Hodgkin lymphoma. It includes the drugs bleomycin sulfate, etoposide phosphate, doxorubicin hydrochloride (Adriamycin), cyclophosphamide, vincristine sulfate (Oncovin), procarbazine hydrochloride, and prednisone.

What is the most aggressive chemotherapy? ›

Doxorubicin is considered one of the strongest chemotherapy drugs for breast cancer ever invented. It can kill cancer cells at every point in their life cycle, and it's used to treat a wide variety of cancers, not just breast cancer. Doxorubicin is also known as “The Red Devil” because it is a clear bright red color.

How effective is BEACOPP? ›

Overall survival is 97%. Early intensification followed by less intense response-based therapy for rapidly responding patients is an effective strategy for achieving high event-free survival in children with high-risk HL.

What is the most common chemotherapy for Hodgkin's lymphoma? ›

Chemotherapy drugs used for Hodgkin lymphoma

The most common combination used to treat HL is called ABVD. This chemotherapy is given every 2 weeks for 2 to 8 months, depending on the stage and response to treatment. ABVD includes doxorubicin, bleomycin, vinblastine and dacarbazine.

What are the long term side effects of BEACOPP? ›

BEACOPP can increase the risk of developing a second cancer or a blood disorder called myelodysplastic syndrome years later.

What does ABVD chemo stand for? ›

An abbreviation for a chemotherapy combination used to treat Hodgkin lymphoma. It includes the drugs doxorubicin hydrochloride (Adriamycin), bleomycin sulfate, vinblastine sulfate, and dacarbazine. Also called ABVD.

What are the toughest cancers to beat? ›

If defining "fastest-killing" cancer is based on which cancer has the worst 5-year relative survival rate, then it would be a tie between pancreatic cancer and malignant mesothelioma (a relatively rare cancer in the U.S. with about 3,000 cases a year).

What is aggressive chemotherapy treatment? ›

Chemotherapy is an aggressive form of chemical drug therapy meant to destroy rapidly growing cells in the body. It's usually used to treat cancer, as cancer cells grow and divide faster than other cells.

What are the two most aggressive cancers? ›

The top five most aggressive cancers are:
  • Lung cancer.
  • Colorectal cancer.
  • Breast cancer.
  • Pancreatic cancer.
  • Prostate cancer.
Oct 26, 2021

What is the best chemo for non Hodgkin's lymphoma? ›

The most common treatment is CHOP, which is made up of the drugs cyclophosphamide, doxorubicin, vincristine and prednisolone. You usually have CHOP with the targeted drug rituximab (Mabthera). This is called R-CHOP. If the lymphoma comes back, you might need treatment with different combinations of drugs.

What is the most difficult lymphoma to treat? ›

Blastic NK cell lymphoma

This very rare type of T cell lymphoma only affects a few people each year. It usually affects adults. Blastic NK cell lymphoma tends to grow very quickly and can be difficult to treat.

Can you get rid of lymphoma without chemo? ›

Non-Hodgkin lymphoma is usually treated with chemotherapy or radiotherapy, although some people may not need treatment straight away. In a few cases, if the initial cancer is very small and can be removed during a biopsy, no further treatment may be needed.

How many rounds of chemo is normal for Hodgkin's lymphoma? ›

A typical chemotherapy regime for Hodgkin lymphoma might involve around six cycles of a combination of drugs, given over a period of six months.

How many rounds of chemo for stage 3 Hodgkin's lymphoma? ›

Treatment for stage 3 Hodgkin lymphoma, is generally between 6 to 8 cycles of chemotherapy. You might have steroids as part of this. And you may also have radiotherapy.

What is the newest treatment for Hodgkin's lymphoma? ›

Advancements in Hodgkin Lymphoma Treatments

Hodgkin lymphoma treatments are also being researched, and new treatment therapies have recently been approved. One new approach is for a targeted therapy with the use of brentuximab vedotin (Adcetris).

What is the most life threatening side effect of chemotherapy? ›

For example, some types of chemotherapy may cause permanent damage to the heart, lungs, liver, kidneys, or reproductive system. And some people have trouble with thinking, concentrating, and memory for months or years after treatment. Cancer survivors also have a higher risk of second cancers later in life.

Can chemo side effects be permanent? ›

The side effects of chemotherapy can linger for months and sometimes years. It depends on your overall health and the type of chemotherapy you receive as treatment. Some complications of chemotherapy are permanent. These can include damage to your respiratory, circulatory, sensory, excretory, and reproductive systems.

Can chemo cause long term heart problems? ›

These side effects, including high blood pressure, abnormal heart rhythms, and heart failure, can be caused or exacerbated by chemotherapy and radiation therapy, as well as by newer forms of cancer treatment, such as targeted therapies and immunotherapies.

Can Hodgkin's lymphoma be completely cured? ›

Overall, treatment for Hodgkin lymphoma is highly effective and most people with the condition are eventually cured.

Can chemotherapy cure Hodgkin's lymphoma? ›

Usually chemotherapy works very well for most people with Hodgkin lymphoma. But sometimes the lymphoma may not completely respond to the treatment. If this happens it can still be treated successfully. Your doctor may talk to you about having more intensive chemotherapy with a stem cell transplant.

How long do you have to live with Hodgkin's lymphoma? ›

Survival for all stages

around 90 out of 100 (around 90%) survive their cancer for 1 year or more after diagnosis. more than 80 out of 100 (more than 80%) survive their cancer for 5 years or more after diagnosis. 75 out of 100 people (75%) survive their cancer for 10 years or more after they are diagnosed.

What are the two different types of treatment for Hodgkin lymphoma? ›

The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy. Occasionally, chemotherapy may be combined with steroid medicine. Some people also have biological medicines. Surgery isn't generally used to treat the condition, except for the biopsy used to diagnose it.

What is the difference between types of Hodgkin lymphoma? ›

If a specific type of cell called a Reed-Sternberg cell is seen, the lymphoma is classified as Hodgkin's. If the Reed-Sternberg cell is not present, the lymphoma is classified as non-Hodgkin's.

What is de escalation chemotherapy? ›

Fundamentally, studying de-escalation treatment approaches mean that we're evaluating the idea of giving less rather than giving more. It could mean cutting back on the number of chemotherapy drugs given or even eliminating chemotherapy altogether.

What's the difference between Hodgkin's lymph phoma and non-Hodgkin's lymphoma? ›

The primary difference between Hodgkin and non-Hodgkin lymphoma is the type of lymphocyte that is affected. Hodgkin lymphoma is marked by the presence of Reed-Sternberg lymphocytes, which a physician can identify using a microscope. In non-Hodgkin lymphoma, these cells are not present.

What is the best treatment for Stage 2 Hodgkin's lymphoma? ›

Treatment for stage 2 Hodgkin lymphoma is usually 2 to 4 cycles of chemotherapy. You might also have radiotherapy.

What is the first line treatment for Hodgkin's lymphoma? ›

First-line chemotherapy

Newly diagnosed Hodgkin lymphoma is often treated with regimens that use a combination of chemotherapy drugs given at 1 time. The most commonly used combination of drugs in the United States is referred to as ABVD.

What is the second line chemotherapy for Hodgkin's lymphoma? ›

The current standard secondary treatment for the majority of patients consists of combination therapy, usually followed by autologous stem cell transplantation (in which a patient's own stem cells are used). Involved site radiation therapy (ISRT) may also be used.

Which is more serious Hodgkin's or non-Hodgkin's lymphoma? ›

non-Hodgkin lymphoma depends on each patient's specific situation, but in general, the five-year relative survival rate for Hodgkin lymphoma is higher than that of non-Hodgkin lymphoma. One reason may be that non-Hodgkin lymphoma is often diagnosed when the cancer is more advanced.

Which is more aggressive Hodgkin's or non-Hodgkin's lymphoma? ›

“T-cell non-Hodgkin lymphomas tend to be more aggressive,” Strati says.

Which is better to have Hodgkin's lymphoma or non-Hodgkin's lymphoma? ›

Hodgkin's lymphoma is one of the most curable cancers. It typically has a better outlook than non-Hodgkin's lymphoma. However, many factors can affect your outlook, such as: your age.

How long does aggressive chemo last? ›

Average length of chemotherapy

One course of chemo treatment may last between 3 to 6 months. Typically, one course consists of several on-and-off cycles. One cycle usually lasts 2 to 6 weeks.

What is end stage chemotherapy? ›

When chemotherapy is used in the second situation, it's called palliative chemotherapy. Palliative chemotherapy is typically used when the cancer has spread and chemotherapy is not being used to cure the cancer. The main goal of palliative treatment is to improve quality of life.

How long does aggressive chemotherapy take? ›

A course of chemotherapy usually takes between 3 to 6 months, although it can be more or less than that. The treatment will include one or more chemotherapy drugs. You may have the chemotherapy into a vein (intravenous drugs), or as tablets or capsules.

What is the most aggressive lymphoma? ›

Burkitt lymphoma: Considered the most aggressive form of lymphoma, this disease is one of the fastest growing of all cancers. Burkitt lymphoma, named for the surgeon who first identified the cancer in the 1950s, accounts for about 2 percent of all lymphoma diagnoses.

How fast does B cell lymphoma spread? ›

They usually grow quite quickly, over just a few weeks. Sometimes, DLBCL can develop in lymph nodes deep inside your body where they can't be felt from the outside. The swollen nodes can form large lumps – known as 'bulky disease'. DLBCL can also develop outside lymph nodes, called 'extranodal' disease.

Which is worse B-cell or T-cell lymphoma? ›

Hence T-cell lymphomas are worse than B-cell lymphomas.

References

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