HD2000 update - ABVD or BEACOPP? Which is a better treatment option?

In late August, LymphomaHub reported on an article comparing ABVD with BEACOPP in the treatment of Hodgkin Lymphoma (HL). The long-term results from the HD2000 trial by Merli, F. et al., published in the Journal of Clinical Oncology, compared 10-year data for three different treatments for HL. These were six cycles of ABVD, six cycles of CEC, and four cycles e-BEACOPP then two cycles of s-BEACOPP. They did not find a statistical difference in 10-year Overall Survival (OS) or Progression Free Survival (PFS) between the three different treatment groups. The author’s data showed that second malignancies were higher in the BEACOPP and CEC groups compared with the ABVD group with 10-year incidence rates of 6.6% (95% CI, 2.4% to 13.8%), 6% (95% CI, 1.8% to 13.9%) and 0.9% (95% CI, 0.1% to 4.5%) respectively.

In a subsequent correspondence by Vassilakopoulos, T.P. and Johnson, P.W.M. in the Journal of Clinical Oncology, it was suggested that there were potential issues in the way in which the secondary malignancy analysis was performed. This stemmed from the reporting in the original article that 6 patients assigned to CEC and 9 patients assigned to BEACOPP actually received ABVD, but only one patient assigned to ABVD was treated with CEC. Vassilakopoulos and Johnson suggested that these deviations might have numerically affected the results in favor of ABVD. Furthermore, they stated that other trials, including a network meta-analysis, had reported higher OS for BEACOPP compared with ABVD than those reported by Merli, et al.

Recently, Merli, F. et al. responded to these issues raised by Vassilakopoulos and Johnson in a correspondence published in the Journal of Clinical Oncology in October 2016. They reported that the main reason for treatment change was from a medical decision or patient request. Furthermore, they stated that secondary malignancy in an Intention-To-Treat (ITT) analysis published was also supported by a per-protocol analysis. They also stated that following per-protocol analysis, 10-year OS rates were 85% (95% CI, 76% to 91%) for ABVD and 84% (95% CI, 73% to 90%) for BEACOPP. Merli F. et al. concluded by stating that the per-protocol analysis confirmed their published ITT analysis and that BEACOPP had better disease control than ABVD, but with more late events resulting in a similar OS for both BEACOPP and ABVD. The results of further studies will be required before there is an answer as to which treatment option is better and under what circumstances.

The complete article by Merli et al., can be found here.

The letter to the editor by Theodoros P. Vassilakopolous and Peter W. M. Johnson can be found here.

The subsequent correspondence by Merli et al., can be found here.