Is BEACOPP better than ABVD?

The majority of patients with advanced Hodgkin's lymphoma are cured with currently available therapy, such as ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine). However, almost 20% of patients fail to achieve a complete remission and almost 40% relapse with prolonged follow-up. BEACOPP (bleomycin, etoposide, Adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) was developed by the German Hodgkin's Study Group to improve on standard therapy by intensifying treatment and substituting the active agent etoposide for vinblastine and dacarbazine. Promising results led to the HD9 trial, in which escalated BEACOPP was superior to COPP/ABVD (cyclophosphamide, vincristine, prednisone, procarbazine/ABVD). Nevertheless, escalated BEACOPP is myelosuppressive and is associated with an increased risk of secondary malignancies. Modifications of BEACOPP have been developed in an attempt to increase efficacy and reduce the adverse effects. Whether BEACOPP should be selected in preference to ABVD may be determined by clinical stage, patient age, and other risk factors. The answer to whether escalated BEACOPP is superior to ABVD will require the results of an ongoing randomized trial.