What is the treatment of choice for advanced-stage Hodgkin's lymphoma: ABVD, Stanford V, or BEACOPP?

The combination of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) is the most commonly used chemotherapy regimen in North America for the treatment of advanced-stage Hodgkin's lymphoma. Although 60% to 70% of patients with stages III and IV Hodgkin's lymphoma may be cured with ABVD, many patients relapse or progress despite standard therapy. Two new regimens, BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) and Stanford V (vinblastine, doxorubicin, vincristine, bleomycin, mustard, etoposide, and prednisone), have shown short-term (3-5 years) overall survival results of 90% or better. Although the results of pilot studies using these regimens and one randomized trial with BEACOPP look promising, the toxicities are substantial. To evaluate overall benefit, two large intergroup trials are underway comparing ABVD versus BEACOPP (European Organization for Research and Treatment of Cancer 20012) and ABVD versus Stanford V (E2496) in advanced Hodgkin's lymphoma.