The BEACOPP (bleomycin, etoposide, adriamycine, cyclophosphamide, vincristine, procarbazine, and prednisone) regimen was developed to improve treatment results by dose intensification achieved by reduced duration of treatment (time intensification) and addition of etoposide. It has been studied in various permutations for over a decade. A randomized trial found that escalating dose BEACOPP increased freedom from treatment failure and overall survival at 5 years compared with COPP-ABVD and fixed dose BEACOPP. It also found that escalating dose BEACOPP increased the proportion of men with sterility, haematological adverse effects, and acute myeloid dysplastic syndrome compared with COPP-ABVD and BEACOPP. A recent BMJ clincial evidence review concluded: "Despite limited Randomized Comparative Trials evidence, there are increasing data that escalating doses of BEACOPP are effective in improving overall survival and freedom from disease; however, their long term safety profile has not been fully explored". The most recent Italian guidelines recommend ABVD for all situations whereas NCCN (p. 14) lists escalated BEACOPP as an option.
Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med 2003;348:2386–2395.
http://clinicalevidence.bmj.com/ceweb/conditions/bly/2404/2404_I14.jsp
Ercole Brusamolino, Andrea Bacigalupo, Giovanni Barosi, Giampaolo Biti, Paolo G. Gobbi, Alessandro Levis, Monia Marchetti, Armando Santoro, Pier Luigi Zinzani, and Sante Tura
Classical Hodgkin’s lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up
Haematologica 2009 94: 550-565; published online before print as doi:10.3324/haematol.2008.002451
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