Increased Doses of Chemotherapy Improves Survival in Advanced Hodgkin's
According to a recent article published in The New England Journal of Medicine, increased doses of the chemotherapy regimen known as BEACOPP improves survival in patients with advanced Hodgkin's disease.
Hodgkin’s disease is a cancer of the lymph system, which is part of the immune (infection fighting) system that includes blood vessels, bone marrow, lymph nodes and lymph vessels that are present throughout the body. It also includes organs such as the spleen, thymus and tonsils. This cancer is characterized by the presence of the uncontrollable growth and division of atypical white blood cells (immune cells) that crowd lymph tissue, suppressing the formation and function of other cells normally found in this tissue.
In general, Hodgkin's disease had a relatively high cure rate. Early Hodgkin's disease has a higher cure rate than more advanced stages of the disease. There has been an apparent plateau on improving survival for patients with advanced Hodgkin’s disease over the past 10 or more years. One of the standard chemotherapy regimens is COPP-ABVD which includes cyclophosphamide, vincristine, procarbazine, and prednisone combined with doxorubicin, bleomycin, vinblastine, and dacarbazine. Another, newer, standard regimen is BEACOPP which includes bleomycin, etoposide, and doxorubicin added to the COPP regimen.
In a recent clinical trial, researchers from Germany conducted a clinical trial to directly compare different chemotherapy regimens in patients with advanced Hodgkin's disease. This trial involved approximately 1,000 patients who were treated with either standard-dose BEACOPP, increased-dose BEACOPP or COPP-ABVD and were directly compared. Seventy percent of patients also received radiation therapy. Patients treated with increased doses of BEACOPP had improved survival and reduced rates of cancer recurrence, compared to the other two regimens. Approximately 5 years following therapy, cancer recurrence rates were 31% for patients treated with COPP-ABVD, 24% for patients treated with BEACOPP and only 13% for patients treated with increased doses of BEACOPP. Survival at 5 years following therapy was 83% for patients treated with COPP-ABVC, 88% for those treated with BEACOPP and 91% for those treated with increased doses of BEACOPP. Low levels of blood cells was a more common side effect in the group of patients treated with increased doses of BEACOPP, compared to the other two groups; however, side effects were manageable. In addition, hematologic (blood) cancers developed as a complication of therapy in .4%, .6% and 2.5% of patients treated with COPP-ABVD, BEACOPP and increased-dose BEACOPP, respectively.
The researchers concluded that increased-doses of BEACOPP reduce recurrence rates and improve survival compared to standard BEACOPP or COPP-ABVD in patients with advanced Hodgkin's. The possibility exists that radiation therapy may have increased the rate of the development of hematological cancers in the group of patients treated with increased-dose BEACOPP. Patients with advanced Hodgkin's disease may wish to speak with their physician about the risks and benefits of increased-dose BEACOPP.
Reference: Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced hodgkin’s disease.
The New England Journal of Medicine. 2003;348;2386-2395.
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