Escalated beacopp ebeacopp is an effective but fairly toxic regimen for the treatment of hodgkin lymphoma hl. In this article we summarize the theoretical arguments which led us in the german hodgkins disease study group to introduce the beacopp regimen and to initiate a large randomised trial to investigate the role of moderate dose escalation in the treatment of advanced stage hodgkins disease. Standard therapy of advanced hodgkin lymphoma hematology. Used to stimulate appetite in cancer patients with severe appetite problems. Chemoresistance as a function of the pretherapy tumor burden. Advani, md, saul rosenberg professor of lymphoma, stan ford cancer institute, summarized current standard treatment options for classic. Aug 16, 2016 to compare the efficiency of doxorubicin, bleomycin, vinblastine, and dacarbazine abvd against that of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone beacopp for treating hodgkin lymphoma hl. Will it be another 20 years before hodgkin lymphoma patients. Outcomes for patients with favourablerisk, earlystage disease are excellent, and serial reductions in intensity of treatment have been made to retain the excellent prognosis while reducing the late effects of treatment. Prior to the middle of the twentieth century chl was fatal in the majority of cases. Fertility in male patients with advanced hodgkin lymphoma. Fertility in young patients following treatment for.
There are two international standards for the treatment of early unfavourable or advanced stage hl. At 34 months, the ffp rate was 90% and the os was 97%. Your doctor will talk to you about this treatment and its possible side effects before you agree consent to have treatment. However, progressionfree survival for pet2 positive patients was much better than expected, exceeding even the outcome of pet2unselected patients in the previous hd15 trial. Patients who have negative results on interim pet are reduced to abvd, which is very well tolerated, whereas. Beacopp, which may be followed by radiation therapy. The 3armed multicentre hd9 trial recruitment 19931998. Beacopp is a safe regimen even in the immunocompromised patient.
Overall, this regimen was found to have the efficacy of. Intensive regimen as beacopp escalated has been restricted to patients younger than 60 years in the majority editorial to avoid bleomycin from hodgkins regimen. If toxic effects occur in two successive cycles, standard doses should be used for all subsequent cycles. Developments in chemotherapy including the mechlorethamine, vincristine. Beacopp proved to be superior to cyclophosphamide, vincristine, procarbazine and prednisone coppabvd in hivnegative patients with advanced stage hd. The rathl and swog studies support existing data for the prognostic utility of pet2. The randomised hd9elderly trial examined beacopp baseline compared to coppabvd in patients older than 65 years and showed no statistically significant difference for overall survival 50% overall survival rate at five years in both arms, but an important higher rate of toxic deaths, 21% compared to 8%, after treatment with beacopp baseline. Treatment with escalated beacopp achieved a superior time to treatment failure over abvd in patients with disseminated hodgkin lymphoma. A regimen is repeated until a defined number of cycles has been completed. Before treatment, 6 23% patients had normozoospermia and 20 77% patients had dysspermia.
At present, a phase 3 trial comparing brentuximab vedotin plus avd to abvd alone is ongoing clinicaltrials. The beacopp regimen was determined on the basis of early reports from the hd12 trial suggesting that there was a better sideeffect profile and similar efficacy with the regimen of four escalated courses followed by. In 1990, the german hodgkin study group ghsg developed a doseescalated and accelerated combined modality regimen consisting of. Blenoxane used in the treatment of squamous cell cancers, melanoma, sarcoma, testicular cancer, hodgkins and nonhodgkins lymphoma. However, additional considerations, balancing treatmentrelated toxicity and late morbidity due to salvage may help with decisionmaking with regard to treatment with abvd or beacopp. Early, intermediate and advanced hodgkins lymphoma annals of. Download pdf design in this prospective, multicenter, randomized and openlabel trial, patients in the standard group are treated with either 4 or 6 cycles of escalated beacopp according to the results of the interim staging pet2 negative patients receive 4 cycles of escalated beacopp, pet2 positive patients receive 6 cycles of escalated. State of the art in the treatment of hodgkin lymphoma. The beacopp regimen was determined on the basis of early reports from the hd12 trial suggesting that there was a better sideeffect profile and similar efficacy with the regimen of four escalated courses followed by four standard cours.
The occurrence of nine cases of acute leukemia after increaseddose beacopp seems alarming, especially as compared with the low leukemogenicity of the abvd regimen. Depending on clinical stage, risk factors and the treatment. The kind of chemotherapy and number of administered cycles depends. Abvd versus beacopp for hodgkins lymphoma when highdose salvage is planned. The ghsg hd12 trial is a fourarm study for patients with bulky stage iib and stages iii to iv disease comparing eight cycles of doseescalated beacopp. The trial was designed to test the hypotheses that riskadapted beacopp, irrespective of the primary risk group, results in a similar efs rate as the escalated beacopp arm observed in the hd9 of the german hodgkin study group. Federico and colleagues state that beacopp data are mainly from patients treated within the german hodgkin study group ghsg, which might bias the results towards beacopp. First, the researchers compared beacopp regimens six cycles of. Cepp regimen cyclophosphamide, etoposide, procarbazine and. Jun 23, 2014 given his deranged liver and renal function, abvd regimen was not the best choice.
Instead, the cepp regimen cyclophosphamide 600 mgm2 in 250 ml ns on day 1 and 8. Although beacopp escalated was more toxic than most other regimen used in advancedstage hl, these results challenge the standard of. Third, data for beacopp treatment outside ghsg was inferior, with an estimated 5. This regimen, as compared with coppabvd, has been shown to lead to better tumor control and to an 11% increase in overall survival at 10 years, and the ghsg has advocated beacopp as the new standard of treatment for patients with highrisk, advancedstage hodgkins lymphoma. As treatment of certain kinds of autoimmune diseases, skin conditions, asthma and other lung conditions. Population pharmacokinetics of the beacopp polychemotherapy. Web to pdf convert any web pages to highquality pdf.
Introduction of single agent radiotherapy rt demonstrated for the first time that these patients could be cured. Volume 8, supplement 2, december 2007, pages s63s66. Two escalated followed by six standard beacopp in advanced. To improve longterm results in advanced hodgkins lymphoma hl has been a continuous challenge from many years.
To treat nausea and vomiting associated with some chemotherapy drugs. In an attempt to reduce treatment related toxicity, the ghsg explored the efficacy of modified versions of the beacopp regimen. Beacopp chemotherapy is a highly effective regimen in children and adolescents with highrisk hodgkin lymphoma. More recently, the ghsg developed a 14day variant of the standard beacopp regimen. As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma. Beacopp is a chemotherapy regimen for treatment of hodgkin lymphoma developed by the german hodgkin study group used for patients in stages ii or early ia or ib with unfavorable risk factors. Prophylactic use of filgrastim with abvd and beacopp. Updates in treatment strategies for hodgkin lymphoma. An extensive englishlanguage literature retrieval on clinical outcomes after treatment by abvd versus beacopp was conducted on medline. Two drugs doxorubicin and bleomycin of the 4 in the abvd and the 7 in the beacopp are common to both regimens. The acute toxicity of the two escalated plus six standard beacopp regimen explored herein is generally what would be expected from previously published series 4, 5, 10. Comparison of the efficiency of abvd versus beacopp for. Kelly, richard sposto, raymond hutchinson, vickie massey, kathleen mccarten, sherrie perkins, mark lones, doojduen villaluna, michael weiner.
Maintaining the planned dose intensity is considered an important goal to achieve when using curative therapy. High incidence of aseptic hip necrosis in hodgkin lymphoma. However, despite this therapeutic efficacy, hl survivors show a higher morbidity and mortality than other people of the same age because of longterm therapyrelated events. Our study shows the feasibility and efficacy of the beacopp regimen in hivhd patients. Slow bolus injection over 2 3 minutes into the sidearm of a fast running sodium chloride 0. The beacopp chemotherapy regimen for advanced hodgkins disease employs a rearranged schedule permitting a shortened threeweek cycle. Beacopp baseline regimen for hodgkin lymphoma request pdf. Beacopp therapeutic regimen for patients with hodgkins disease and hiv infection.
May 25, 2017 there are two international standards for the treatment of early unfavourable or advanced stage hl. After each su ch event, the doses of cyclophosphamide and etoposide should be reduced by one level on a fivelevel scale from escalated to standard doses as shown below. Updates in treatment strategies for hodgkin lymphoma presented by ranjana h. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Beacopp therapeutic regimen for patients with hodgkins.
Pdf escalateddose beacopp in the treatment of patients with. Thus, pet2 cannot identify patients at highrisk for. Skoetz and colleagues note that the beacopp regimen is already the standard of care used by the german hodgkin study group to which they belong, the lymphoma study. Beacopp chemotherapy is a highly effective regimen in children and adolescents with. Abvd and escalated beacopp are internationally accepted as appropriate firstline. Abvd versus beacopp for hodgkins lymphoma when highdose. Avascular necrosis avn of femoral head was previously reported to increase in patients treated with ebeacopp, but so far, no systematic analysis of its frequency has been published. Model based development of the beacopp regimen for. Patients typically receive treatment in cycles of 21 days with no drugs given on days 1521. Therefore, prophylactic use of granulocyte colonystimulating factor gcsf is widely used to support these regimens and is mandatory to support beacopp escalated and beacopp 14 to reduce toxicity and treatment delays. Riskadapted beacopp regimen can reduce the cumulative.
Riskadapted beacopp regimen can reduce the cumulative dose. If the inline pdf is not rendering correctly, you can download the pdf file here. Brentuximab vedotin should not be given with bleomycin in general or specifically as firstline therapy for patients with treatment naive, advanced stage hodgkins lymphoma. Nevertheless, escalated beacopp therapy is associated. Third, there was a concern that data for beacopp treatment outside ghsg was inferior. Therapyrelated late adverse events in hodgkins lymphoma. Intensified chemotherapy regimen showed an advantage over standard regimen in terms of antitumoral activity, however haematological and nonhaematological toxicities were significantly. Updates in treatment strategies for hodgkin lymphoma in. Beacopp chemotherapy is a highly effective regimen in children.
Compared with standard dose beacopp or abvd, escalated beacopp is an intensive regimen with higher drug. Will it be another 20 years before hodgkin lymphoma patients benefit from beacopp therapy. We examined 29 patients treated by means of the abvd regimen and 34 treated with the beacopp regimen. In an attempt to reduce treatmentrelated toxicity, the ghsg explored the efficacy of modified versions of the beacopp regimen.
The treatment of patients with hodgkin lymphoma hl has been one of the major success stories in medical oncology. The ghsg and others have explored modifications of the doseescalated beacopp regimen, including doseescalated beacopp followed by standarddose beacopp 49 and the beacopp 14 regimen, 50,51 a timeintensified variant of standarddose beacopp. These significantly improved os and fftf rates for patients with advanced hodgkins lymphoma were suggestive for improvement of the clinical outcomes by escalated beacopp. We evaluated the impact of beacopp regimen on fertility status in 38 male patients with advancedstage hl enrolled into trials of the german hodgkin study group ghsg. The purpose of this study was to determine the fertility rates following treatment by means of the beacopp regimen regular and escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone as compared to the abvd regimen doxorubicin, vinblastine, dacarbazine, bleomycin in hodgkin lymphoma patients under the age of 40 at the time of treatment. Beacopp bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone was developed by the german hodgkins study group to improve on standard therapy by intensifying treatment and substituting the active agent etoposide for vinblastine and dacarbazine. Escalateddose beacopp in the treatment of patients with. However, recent clinical trials have failed to confirm beacopp overall survival os superiority over abvd. This postulation would imply that treatment results, irrespective of the regimen used, are better in ghsg centres than in centres that use abvd.
With haematological growth factor support, the dosages of. Abstractthe study was conducted to compare the presence of cardiotoxicity after the treatment of hodgkins disease with the standard abvd or beacopp protocol. Evaluation of acute and early cardiotoxicity in survivors of. Standard and increaseddose beacopp chemotherapy compared. Beacopp is a chemotherapy regimen for treatment of hodgkin lymphoma developed by the. Moreover, dose intensification from abvd to beacopp in petpositive patients with poor prognoses produced impressive pfs compared with historic controls, providing the rationale for individualized treatment. Also used to treat pleural effusion build up of fluid in the space between the lining of the lung and the chest wall. To compare the efficiency of doxorubicin, bleomycin, vinblastine, and dacarbazine abvd against that of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone beacopp for treating hodgkin lymphoma hl. Chemotherapy or brentuximab vedotin is first used to shrink the cancer. Pdf beacopp, a new doseescalated and accelerated regimen. Pdf abvd versus beacopp for hodgkins lymphoma when high. There is clear consensus that anthracyclinebased chemotherapy with doxorubicin, bleomycin, vinblastine and dacarbazine abvd is the gold standard because of its equivalent response rate to therapy and progressionfree survival. Comparison of chemotherapy including escalated beacopp versus.
For full access to this pdf, sign in to an existing account, or purchase an annual. Guide to combination cancer chemotherapy regimens dominic a. In addition, the gain in lowrisk patients is still a matter of debate. Use pdf download to do whatever you like with pdf files on the web and regain control. The doseescalated beacopp regimen etable 761, developed by the ghsg, yielded. Beacopp beats advd for survival in hodgkins lymphoma. An extensive englishlanguage literature retrieval on clinical outcomes after treatment by abvd versus beacopp was conducted on medline, pubmed, and.
Jun, 2011 the fact that a chemotherapy regimen that is more doseintense and more dosedense, as is the beacopp in comparison with abvd, can better overcome chemoresistance confirms that the resistance of tumor cells is relative, not absolute. Compared with standard dose beacopp or abvd, escalated beacopp is an intensive regimen with higher drug dosage in particular a 100% increase of etoposide. Pdf the hd9 trial aims to evaluate whether moderate dose escalation andor acceleration of standard polychemotherapy is. The beacopp regimen is feasible at moderate hematopoeitic toxicity. Hodgkins lymphoma hl is one of the most curable hematologic diseases with an overall response rate over 80%. We are not aware of any evidence to support this theory. The beacopp regimen proved to be a successful treatment of unfavorable hd in the hivnegative population 15, 24. Beacopp is named after the initials of the drugs used. The management of classical hodgkins lymphoma chl is a success story of modern multiagent haematooncology.
With haematological growth factor support, the dosages of cyclophosphamide, etoposide and adriamycin could be moderately escalated. Will it be another 20 years before hodgkin lymphoma. Prognosis is also very good in advancedstage disease but the rate of relapse is higher than in earlystage disease. Sep 30, 2012 the beacopp bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone chemotherapy regimen for the treatment of advanced hodgkins lymphoma has a superior outcome, but its toxicity mainly haematotoxicity is pronounced and highly variable. However, they criticise exposing all patients to at least two cycles of beacopp escalated instead of petdriven upfront abvd treatments and conclude that starting treatment with the more toxic beacopp escalated regimen. The addition of rituximab to beacoppescalated did not improve the progressionfree survival of pet2 positive patients with advanced stage hodgkins lymphoma. Beacopp chemotherapy is a highly effective regimen in. Of interest, haematological toxicity except thrombocytopenia appears similar for the less doseintense courses when these are applied after two cycles of escbeacopp. Beacopp, a new doseescalated and accelerated regimen, is at least as effective as coppabvd in patients with advancedstage hodgkins lymphoma. Petguided, beacopp escalated therapy in advanced hodgkin. Modifying therapy in patients with advanced hodgkins. Fewer progressionsrelapses were observed with beacopp, demonstrating the high efficacy of the more intensive regimen, even in lowrisk patients. Abvd compared with beacopp compared with cec for the initial.
The ghsg hd12 trial is a fourarm study for patients with bulky stage iib and stages iii to iv disease comparing eight cycles of doseescalated beacopp with or without radiation therapy, versus four cycles of escalated and four cycles of baseline beacopp with or. Cancer that grows during or soon after firsttime treatment is called refractory disease. The present study was conducted to address the role of pharmacokinetics in individual toxicity. The other strategy for initial therapy involves starting patients on the more intensive beacopp regimen. After all cycles of chemotherapy have been administered, a radiotherapy is conducted if necessary. The treatment of advanced hl has been advanced and refined by the conduct of numerous large multicenter randomized controlled trials rcts. A prospective randomised trial has been initiated to compare the beacopp regimen with the standard coppabvd regimen in advancedstage hodgkins disease. Beacopp, an intensified regimen consisting of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, has been advocated as the new standard of treatment for advanced hodgkins lymphoma, in place of the combination of doxorubicin, bleomycin, vinblastine, and dacarbazine abvd. Firstline escalated beacopp does not hinder stem cell.
Beacopp acronym chemotherapy regimen for hodgkins lymphoma. Management of hodgkins lymphoma continues to develop. With a fftfrate of 89% at a median followup of 40 months, the treatment results are very encouraging. It is best to read this information with our general information about chemotherapy and the type of cancer you have.
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