Drop it like it’s (not) hot.

We’re talking toxic chemo. For advanced Hodgkin lymphoma, escalated BEACOPP is an intensive chemo regimen that improves progression-free survival (PFS), but it’s at the expense of more toxicity than standard ABVD. The NCCN suggests BEACOPP either as a stand-alone course x 6 cycles or as intensified therapy for those with interim PET progression on ABVD. In AHL2011, that approach was flipped to see if intensive BEACOPP up-front could be de-escalated to ABVD based on interim PET response with a primary endpoint of non-inferior PFS. After two cycles of BEACOPP, 85% of patients in the experimental arm were able to de-escalate to ABVD based on a negative interim PET. That group maintained essentially the same rate of PFS at 86%, while serious adverse events were almost halved from 47→ 28%. TBL: A PET-adapted de-escalation of BEACOPP maintains PFS while reducing toxicity among patients less than age 60 with advanced Hodgkin lymphoma. | Casasnovas, Lancet Oncol 2019