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 :

Patient Characteristics

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 :

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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	v.diehl@uni-koeln.de 5 Years ago.



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