Beacopp regimen

The majority of patients with advanced HL are cured with standard anthracycline-based treatments. Approximately one-third of such patients fails to achieve a long-term remission and therefore may benefit from a more intensified initial regimen. An accurate prognostic algorithm is necessary to identify patients in whom standard treatment is likely to fail.

In 1998, a seven-factor prognostic scoring system that focused on 5-year rates of freedom from progression of disease was developed. This system, known as the international prognosis index (IPI), uses seven independent prognostic factors: serum albumin level of less than 4 g/dL; hemoglobin level of less than 10.5 g/dL; male sex; age of 45 years or older; stage IV disease (according to the Ann Arbor classification); leukocyto-sis (a white-cell count of at least 15,000/mm3); and lymphopenia (a lymphocyte count of less than 600/mm3, a count that was less than 8% of the white-cell count, or both). The score predicted the rate of freedom from disease progression with higher scores associated with increased risk of disease progression.73 The IPI was incorporated in a major German trial where two "intense" regimens, known as BEACOPP (bleomycin, etoposide, adriamycin, cyclophos-phamide, vincristine, procarbazine, and prednisone) were tested against COPP-ABVD, a combination that many experts find equivalent to ABVD.74 A description of these two BEACOPP regimens (baseline and escalated) and COPP-ABVD is outlined in Table 73.7. The BEACOPP regimen was developed in an attempt to improve treatment results in advanced HL by dose and time intensification and addition of etoposide. It employs a schedule permitting a shortened 3-week cycle. With growth factor support, the dosages of cyclophosphamide, etoposide, and adriamycin were moderately escalated. The trial, known as the HL-9 trial, included more than 1000 patients with advanced disease. After a follow-up of more than 50 months, the rate of freedom from treatment failure at 5 years was 69% in the COPP-ABVD arm, 76% in the BEACOPP-baseline arm, and 87% in the escalated-arm BEACOPP arm (P = 0.04) for the comparison of the COPP-ABVD arm with the BEACOPP arms (both the baseline and escalated arms). The 5-year rates of OS were 83% with COPP-ABVD, 88% with BEACOPP-baseline, and 91% with BEACOPP-escalated. Only the comparison of BEACOPP-escalated and COPP-ABVD was statistically significant for OS. Taking into account the IPI, patients with poor risk factors (> four adverse factors) had a much more pronounced benefit from BEACOPP regimens compared to COPP-ABVD, with 5-year OS

Table 73.7 BEACOPP (baseline), BEACOPP escalated, and COPP/ABVD regimens

Regimen

Dosage (mg/m2)

Route

Schedule

Cycle duration

BEACOPP (baseline)

0 0

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