Long-Term Results of the HD2000 Trial Comparing ABVD Versus BEACOPP Versus COPP-EBV-CAD in Untreated Patients With Advanced Hodgkin Lymphoma: A Study by Fondazione Italiana Linfomi.

Abstract

PURPOSE:

The randomized HD2000 trial compared six cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), four escalated plus two standard cycles of BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and six cycles of COPP-EBV-CAD (cyclophosphamide, lomustine, vindesine, melphalan, prednisone, epidoxorubicin, vincristine, procarbazine, vinblastine, and bleomycin; CEC) in patients with advanced-stage Hodgkin lymphoma. After a median follow-up of 42 months, patients who received BEACOPP were reported to have experienced better progression-free survival (PFS) but not better overall survival (OS) results than those receiving ABVD. We here report a post hoc analysis of this trial after a median follow-up of 10 years.

PATIENTS AND METHODS:

Three hundred seven patients were enrolled, 295 of whom were evaluable. At the time of our analysis, the median follow-up for the entire group was 120 months (range, 4 to 169 months).

RESULTS:

The 10-year PFS results for the ABVD, BEACOPP, and CEC arms were 69%, 75%, and 76%, respectively; corresponding OS results were 85%, 84%, and 86%. Overall, 13 second malignancies were reported: one in the ABVD arm and six each in the BEACOPP and CEC arms. The cumulative risk of developing second malignancies at 10 years was 0.9%, 6.6%, and 6% with ABVD, BEACOPP, and CEC, respectively; the risk with either BEACOPP or CEC was significantly higher than that reported with ABVD (P = .027 and .02, respectively).

CONCLUSION:

With these mature results, we confirm that patients with advanced Hodgkin lymphoma have similar OS results when treated with ABVD, BEACOPP, or CEC. However, with longer follow-up, we were not able to confirm the superiority of BEACOPP over ABVD in terms of PFS, mainly because of higher mortality rates resulting from second malignancies observed after treatment with BEACOPP and CEC.

• Authors: Francesco Merli, Stefano Luminari, Paolo G Gobbi, Nicola Cascavilla, Caterina Mammi, Fiorella Ilariucci, Caterina Stelitano, Maurizio Musso, Luca Baldini, Sara Galimberti, Francesco Angrilli, Giuseppe Polimeno, Potito Rosario Scalzulli, Angela Ferrari, Luigi Marcheselli, Massimo Federico
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 34 Issue 11 Pg. 1175-81 (Apr 10 2016) ISSN: 1527-7755 [Electronic] United States
• PMID: 26712220 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 by American Society of Clinical Oncology.

Chemical References

• Bleomycin
• Procarbazine
• Epirubicin
• Vincristine
• Vinblastine
• Etoposide
• Lomustine
• Dacarbazine
• Doxorubicin
• Cyclophosphamide
• Melphalan
• Vindesine
• Prednisone

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Bleomycin (administration & dosage)
• Cyclophosphamide (administration & dosage)
• Dacarbazine (administration & dosage)
• Disease-Free Survival
• Doxorubicin (administration & dosage)
• Drug Administration Schedule
• Epirubicin (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Follow-Up Studies
• Hodgkin Disease (drug therapy, pathology)
• Humans
• Incidence
• Italy (epidemiology)
• Kaplan-Meier Estimate
• Lomustine (administration & dosage)
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Neoplasm Staging
• Neoplasms, Second Primary (chemically induced, epidemiology)
• Prednisone (administration & dosage)
• Procarbazine (administration & dosage)
• Treatment Outcome
• Vinblastine (administration & dosage)
• Vincristine (administration & dosage)
• Vindesine (administration & dosage)