Standard and Escalated BEACOPP for Advanced Hodgkin Lymphoma 10 year results of the HD9 study of the German Hodgkin Study Group
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Slide 1 :
Ten-year results of a German Hodgkin Study Group randomized trial of standard and increased dose BEACOPP chemotherapy for advanced Hodgkin’s lymphoma (HD9) V. Diehl GHSG GHSG 2007 HD9
Slide 2 :
CS IIB-IIIA with risk factors CS IIIB-IV Arm A 4 × COPP+ABVD ? RT Arm B 8 × BEACOPP baseline ? RT Arm C 8 × BEACOPP escalated* ? RT RT to initial bulk and residual tumor HD9 Trial Design GHSG 2007 HD9 * with G-CSF
Slide 3 :
Recruitment and Analysis randomised in HD9 n = 1282 qualified for HD9 n = 1201 evaluable n = 1196* per arm: A n = 261* B n = 469 C n = 466 ? 99.6% of patients were evaluable * One additional arm A pt. became evaluable since the previous analysis (2004) GHSG 2007 HD9
Slide 4 :
Slide 5 :
Patient Characteristics: IPS
Slide 6 :
Acute Hematological Toxicity
Slide 7 :
Treatment Outcome Radiotherapy * A vs. C: p<0.001 and B vs. C: p<0.001
Slide 8 :
Causes of Death
Slide 9 :
FFTF by treatment arm Log-rank tests: A v B v C p<0.0001 A v B p=0.040 B v C p<0.0001 A v C p<0.0001
Slide 10 :
GHSG 2007 HD9 OS by treatment arm Log-rank tests: A v B v C p=0.0005 A v B p=0.19 B v C p=0.0053 A v C p<0.0001
Slide 12 :
Survival rates according to IPS GHSG 2007 HD9
Slide 13 :
Survival rates according to age of patient GHSG 2007 HD9
Slide 14 :
GHSG 2007 HD9 Secondary Malignancies number of cases and 10-year cumulative incidences (CI)* * allowing for competing risks (deaths from other causes)
Slide 15 :
GHSG 2007 HD9 Survival after Relapse
Slide 16 :
Three Trial Generations of the GHSGHD9, HD12, HD15 (1992–2005) Chemotherapy Radiotherapy Patients (%) HD9: 8 BEACOPP esc + IF-RT (65) HD12: 4 BEACOPP esc + 4 BEA baseline + IF-RT (35) HD15: 6 BEACOPP esc PET+ + IF-RT (<15) 8 BEACOPP-14 baseline PET+ + IF-RT (<15) HD18: 2 BEA esc : PET neg: 2 BEACOPP esc or 4 BEAesc ? no RT PET pos: 4-6 BEACOPP esc +/- Rituximab ? IF-RT
Slide 17 :
BEACOPP escalated Proof of Principle in 3 Randomized Prospective Trials in > 500 centers including 220 private oncologists all over Europe > 2000 patients treated: Results: CR: >90% (RT: 15-65%) FFTF: 82-88%, 4-10 yr follow up OS: 86-90%, 4-10 yr follow up MDS/AML: 0.9%!!!
Slide 18 :
BEACOPP escalated Hodgkin Lymphoma Advanced StagesHow to Identify the Good & Bad Risk Groups? Overall Survival (y) Probability 10 9 8 7 6 5 4 3 2 1 0 1.0 0.8 0.6 0.4 0.2 0.0 Only alkylating agents (1965) No treatment (1940) C/ABVD BEACOPP base 30% failures with ABVD IPS 3–7 PET positive after 2 ABVD? 70% of patients cured with ABVD IPS 0–2 PET negative after 2 ABVD?
Slide 19 :
Comparison with ABVD in trials of advanced stage HL GHSG 2007 HD9
Slide 20 :
Possible Future Strategy...For Advanced HL Months Dose Intensity Over Time 1 2 5 3 4
Slide 21 :
Conclusion Advanced HL : Treat In Clinical Trials!! Possible future strategies Risk-adapted therapy: Using IPS Response-adapted therapy: Using PET Early Intensification with BEACOPP esc in the High Risk Group (> 3 IPS- RFs)
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PowerPoint Presentation on Standard and Escalated BEACOPP for Advanced Hodgkin Lymphoma: 10 year results of the HD9 study of the German Hodgkin Study Group or PowerPoint Presentation on 10 year follow up of the HD9 study of the German Hodgkin Study Group (GHSG) BEACOPP standard and escalated for advanced Hodgkin Lymphoma
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