Diehl V, Behringer K
First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany.
Cancer Invest. 2006 Jun-Jul;24(4):461-5. doi: 10.1080/07357900600705789.
In 1992, the German Hodgkin Study Group (GHSG) developed the BEACOPP regimen for further improving the outcome of patients with advanced Hodgkin's lymphoma (HL). Since then, BEACOPP has been introduced in 3 different prospective randomized clinical trials of the GHSG to find an equilibrium between maximal efficacy and least toxicity with the BEACOPP principle for the treatment of advanced stage HL. In the HD9 trial of the GHSG, with 1,186 patients, after a median observation time of 7 years, the rates for FFTF are 85 percent and for overall survival 90 percent for dose-escalated BEACOPP, and for COPP/ABVD (C/ABVD comparable to ABVD) the rate for FFTF is 67 percent and for overall survival it is 79 percent. These superior BEACOPP results are obtained inspite of a higher rate of secondary AML/MDS in the escalated BEACOPP arm. The number of toxic deaths during treatment, however, was lower for escalated BEACOPP (1.6 percent) than for C/ABVD (1.8 percent). The majority of patients were treated in an outpatient setting, in a multicenter study with more than 400 centers, including 120 private doctors, located in Germany and 9 other European countries. To reduce acute and long-term toxicity, the GHSG started in the consecutive studies HD12 and HD15 for advanced stage HL to de-escalate BEACOPP by reducing the number of escalated BEACOPP cycles and by applying the baseline dose BEACOPP, a time dense regimen, called BEACOPP-14. The excellent results obtained with the BEACOPP principle challenge the seemingly global consensus that ABVD is the gold standard treatment strategy for advanced stage HL.
1992年，德国霍奇金淋巴瘤研究组（GHSG）制定了BEACOPP方案，以进一步改善晚期霍奇金淋巴瘤（HL）患者的治疗效果。从那时起，BEACOPP已被引入GHSG的3项不同的前瞻性随机临床试验中，以根据BEACOPP原则在最大疗效和最小毒性之间找到平衡，用于治疗晚期HL。在GHSG的HD9试验中，有1186例患者，中位观察时间为7年，剂量递增的BEACOPP方案的无失败生存（FFTF）率为85%，总生存率为90%，而COPP/ABVD方案（C/ABVD与ABVD相当）的FFTF率为67%，总生存率为79%。尽管剂量递增的BEACOPP组继发性急性髓系白血病/骨髓增生异常综合征（AML/MDS）的发生率较高，但仍取得了优于BEACOPP的结果。然而，剂量递增的BEACOPP方案治疗期间的毒性死亡人数（1.6%）低于C/ABVD方案（1.8%）。大多数患者是在门诊接受治疗的，该多中心研究涉及德国和其他9个欧洲国家的400多个中心，其中包括120名私人医生。为了降低急性和长期毒性，GHSG在针对晚期HL的后续研究HD12和HD15中，通过减少剂量递增的BEACOPP周期数并应用基线剂量的BEACOPP（一种时间密集型方案，称为BEACOPP-14）来降低BEACOPP的强度。BEACOPP原则所取得的优异结果挑战了ABVD是晚期HL的金标准治疗策略这一似乎已达成的全球共识。
