Commentary

Gerhartz and coworkers (abstract #1293) and the German Hodgkin’s Group (Diehl et al, abstract #2002) presented their results with interoup (Diehl et al, abstract #2002) presented their results with intensified regimens. The former investigators used a time-intensified COPP (cyclophosphamide, Oncovin, procarbazine(Drug information on procarbazine), and prednisone(Drug information on prednisone))/ABVD (Adriamycin, bleomycin, vinblastine(Drug information on vinblastine), and dacarbazine(Drug information on dacarbazine)) regimen with granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine, Prokine]) support. Complete remission rates were 62% with COPP/ABVD, as compared with 79% for the intensified regimen. This was taken as evidence of benefit from the higher-dose program. However, these findings are consistent with results that have been reportedfor ABVD and other anthracycline-containing regimens (Canellos et al:N Engl J Med 327:1478-84, 1992; Duggan et al: Proc Am Soc Clin Oncol 16:12a [abstract 43], 1997).

The German Hodgkin Group recently published their preliminary results with the BEACOPP (bleomycin, etoposide(Drug information on etoposide), Adriamycin, cyclophosphamide(Drug information on cyclophosphamide), Oncovin, procarbazine, and prednisone) regimen (Diehl et al: J Clin Oncol 16:3810-3821, 1998). They described a three-arm randomized trial in which 505 patients were randomized to COPP/ABVD, standard-dose BEACOPP, or dose-escalated BEACOPP, the latter requiring granulocyte colony-stimulating factor (G-CSF [Neupogen]) support. Patients were followed for a median of 23 months. In this trial, COPP/ABVD was inferior to both BEACOPP regimens.

At the ASH meeting, these authors presented an update of this study, which included 1,200 patients. Results of this update showed the continued superiority of BEACOPP over COPP/ABVD. Other regimens, such as the Stanford V program (Horning et al: Ann Oncol 7[suppl 4]:105-108, 1996), have also shown promising results in patients with Hodgkin’s disease. Randomized phase III comparisons are needed to determine whether any of these programs is actually superior to ABVD.

— Bruce D. Cheson, MD