Comparable 3-year outcome following ABVD or BEACOPP first-line chemotherapy, plus pre-planned high-dose salvage, in advanced Hodgkin lymphoma (HL): A randomized trial of the Michelangelo, GITIL and IIL cooperative groups

Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

“…43 In a direct comparison with ABVD, however, a superiority in terms of overall survival for BEACOPP has not yet emerged. 47,48 At variance with the ESMO, the NCCN guidelines recommend escalated BEACOPP only for high-risk patients with an IPS score ≥4 and the SIE-SIES-GITMO guidelines conclude that, based on the currently available evidence, first-line escalated BEACOPP therapy cannot be recommended as a standard, but only evaluated in controlled clinical trials. These discrepancies document that, despite the evidence-based nature of recommendations, there are intrinsic limitations in the process of translating the evidence into practice recommendations.…”

“…A number of randomized studies are being conducted to compare ABVD with BEACOPP; at the moment, however, only data in the form of Abstracts are available. 47,48 The preliminary results of the HD2000 trial, 47 suggest a superiority of BEACOPP over ABVD in terms of FFP but not of OS. In the IIL-GITIL-Michelangelo study, 48 ABVD (6-8 courses) or BEA-COPP (4 escalated+4 baseline) first-line chemotherapy, plus pre-planned high-dose salvage, produced a comparable 3-year outcome.…”

“…47,48 The preliminary results of the HD2000 trial, 47 suggest a superiority of BEACOPP over ABVD in terms of FFP but not of OS. In the IIL-GITIL-Michelangelo study, 48 ABVD (6-8 courses) or BEA-COPP (4 escalated+4 baseline) first-line chemotherapy, plus pre-planned high-dose salvage, produced a comparable 3-year outcome. BEACOPP as up-front therapy scored a superior 3-year FFP (87 vs. 71%); however, freedom from second progression (92 vs. 87%) and OS (90 vs. 91%) were comparable to ABVD as up-front therapy.…”

“…To reach their conclusions, the experts have analyzed the results of randomized clinical trials, either as full papers [33][34][35][36][37][38][39][40][41][42][43][44][45] or abstracts, [46][47][48] and of meta-analyses of randomized clinical trials. 49,50 Evidence for the efficacy of chemotherapy to cure advanced Hodgkin's lymphoma has derived from studies initiated more than 35 years ago, with the introduction into the clinical practice of MOPP (mechlorethamine, vincristine, procarbazine, prednisone) chemotherapy.…”

The Present: Optimizing Therapy—Too Much or Too Little?

“…34,35 In two other randomized trials of escBEACOPP versus ABVD, escBEACOPP was not associated with a survival advantage, despite a lower rate of relapse. 36,37 Importantly, both trials, in an effort to reduce both acute and long-term toxicity, administered a slightly less intensive BEACOPP regimen than the GHSG. In the Gruppo Italiano per lo Studio dei Linformi trial, patients received four cycles of escBEACOPP and two cycles of standard BEACOPP; in the second Italian cooperative group trial by Gianni et al,36 patients received four cycles of escBEACOPP and four cycles of standard BEACOPP.…”