Comparison of first-line chemotherapy including escalated BEACOPP versus chemotherapy including ABVD for people with early unfavourable or advanced stage Hodgkin lymphoma

• Published in: Cochrane database of systematic reviews 2017-05, Vol.5 (5), p.CD007941
• Main Authors: Skoetz, Nicole, Will, Andrea, Monsef, Ina, Brillant, Corinne, Engert, Andreas, von Tresckow, Bastian
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bleomycin - administration & dosage; Bleomycin - adverse effects; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Dacarbazine - administration & dosage; Dacarbazine - adverse effects; Disease Progression; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Etoposide - administration & dosage; Etoposide - adverse effects; Hodgkin Disease - drug therapy; Hodgkin Disease - mortality; Hodgkin Disease - pathology; Humans; Medicine General & Introductory Medical Sciences; Middle Aged; Prednisone - administration & dosage; Prednisone - adverse effects; Procarbazine - administration & dosage; Procarbazine - adverse effects; Randomized Controlled Trials as Topic; Vinblastine - administration & dosage; Vinblastine - adverse effects; Vincristine - administration & dosage; Vincristine - adverse effects; Young Adult
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD007941.pub3

There are two different international standards for the treatment of early unfavourable and advanced stage Hodgkin lymphoma (HL): chemotherapy with escalated BEACOPP (bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone) regimen and chemotherapy with ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine) regimen. To determine the advantages and disadvantages of chemotherapy including escalated BEACOPP compared to chemotherapy including ABVD in the treatment of early unfavourable or advanced stage HL as first-line treatment. We searched for randomised controlled trials in MEDLINE, CENTRAL and conference proceedings (January 1985 to July 2013 and for the update to March 2017) and Embase (1985 to November 2008). Moreover we searched trial registries (March 2017; www.controlled-trials.com, www.clinicaltrialsregister.eu/ctr-search/search, clinicaltrials.gov, www.eortc.be, www.ghsg.org, www.ctc.usyd.edu.au, www.trialscentral.org/index.html) SELECTION CRITERIA: We included randomised controlled trials examining chemotherapy including at least two cycles of escalated BEACOPP regimens compared with chemotherapy including at least four cycles of ABVD regimens as first-line treatment for patients with early unfavourable stage or advanced stage HL. The effect measures we used were hazard ratios (HRs) for overall survival (OS), progression-free survival (PFS) and freedom from first progression.We used risk ratios (RRs) relative risks to analyse harms: treatment-related mortality, secondary malignancies (including myeloid dysplastic syndrome (MDS) or acute myeloid leukaemia (AML)), infertility and adverse events.Quality of life was not reported in any trial, therefore not analysed. Two review authors independently extracted data and assessed quality of trials. We screened 1796 records and identified five eligible trials in total i.e. one trial could be added on the previous review. These trials included only adults (16 to 65 years of age). We included all five trials with 3427 people in the meta-analyses: the HD9 and HD14 trials were co-ordinated in Germany, the HD2000 and GSM-HD trials were performed in Italy and the EORTC 20012 was conducted in Belgium. The overall risk of performance and detection bias was low for overall survival (OS), but was high for other outcomes, as therapy blinding was not feasible. The remaining 'Risk of bias' domains were low and unclear.All trials reported results for OS and progression-free survival (PFS). In