The BEACOPP chemotherapy regimen for advanced Hodgkin's disease employs a r
earranged schedule permitting a shortened three-week cycle. With haematolog
ical growth factor support, the dosages of cyclophosphamide. etoposide and
adriamycin could be moderately escalated. The 3-armed multicentre HD9 trial
(recruitment 1993-1998; 1300 patients randomised) aimed to compare BEACOPP
with the standard COPP/ABVD chemotherapy and to detect and measure the gai
n in efficacy, if any due to moderate dose escalation of BEACOPP. Eight cyc
les were given, followed by local irradiation.
The most recent interim analysis, with 689 evaluable patients, circa 40% of
all expected events and a median observation time of 27 months, showed sig
nificant differences in progression rats (F) and in two-year freedom from t
reatment failure (F) between the treatment arms, with escalated BEACOPP (P
= 2%, F = 89%) better than baseline BEACOPP (P = 9%, F = 81%) better than C
OPP/ABVD (P = 13%, F = 72%). Survival was not significantly different. Acut
e toxicity was more severe due to dose escalation, but remained manageable.
These preliminary results suggest that BEACOPP improves efficacy. Moderate
dose escalation is feasible with G-CSF support and appears likely to make
a worthwhile improvement in the cure rate. The results must await confirmat
ion (or otherwise) by the final analysis including all randomised patients
and sufficiently mature data.