eBEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone in escalated doses) is very active in patients with advanced-stage Hodgkin's lymphoma, but is linked to severe toxicities. Researchers investigated whether individual patients might be cured with less burdensome therapy and in this study, evaluated if metabolic response determined by PET after two cycles of standard regimen eBEACOPP (PET-2) would allow adaption of treatment intensity, increasing it for PET-2-positive patients and reducing it for PET-2-negative patients.
A commentary cautions that the underlying assumption PET can be used to select patients for more or less intense treatment regimens needs further examination, as the prognostic and predictive value of any one factor becomes less effective and will eventually disappear if a treatment is found to cure all patients. It notes that following the trial findings, two questions arise: can the HD18 trial results for patients with negative PET-2 be extrapolated to patients with Deauville score 3 after two cycles of eBEACOPP? Is 4×eBEACOPP as effective for patients with Deauville score 4 as is 6×eBEACOPP when eBEACOPP is administered upfront? It calls for these questions to be formally tested, as the medical community is now left to speculate whether the maximum effect of upfront eBEACOPP is achieved with only four cycles- if so, the reluctance to use eBEACOPP due to its toxicity profile might then be offset by the much increased efficacy and reduced treatment time as compared with doxorubicin, bleomycin, vinblastine, and dacarbazine.