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This Week in NEJM: Jul 21, 2011

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In NEJM this week, researchers in Italy present findings from a study comparing the BEACOPP and ABVD treatment regimens for Hodgkin's lymphoma. BEACOPP is a regimen consisting of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, and has been advocated as the new standard of care for Hodgkin's lymphoma, instead of the ABVD combination which consists of doxorubicin, bleomycin, vinblastine, and dacarbazine, the team writes. The researchers randomly assigned 331 previously untreated Hodgkin's patients to receive either BEACOPP or ABVD, and then followed up for 61 months. "The seven-year rate of freedom from first progression was 85 percent among patients who had received initial treatment with BEACOPP and 73 percent among those who had received initial treatment with ABVD, and the seven-year rate of event-free survival was 78 percent and 71 percent, respectively," the team writes. "Treatment with BEACOPP, as compared with ABVD, resulted in better initial tumor control, but the long-term clinical outcome did not differ significantly between the two regimens."

In a related editorial in NEJM this week, the BC Cancer Agency's Joseph Connors writes that it has been underappreciated until recently that the best choice of primary chemotherapy for Hodgkin's lymphoma is affected by the choice of secondary treatment. With high cure rates now available for limited-stage Hodgkin's lymphoma, the focus has been on reducing the intensity of primary treatment, Connors writes. "Once cure is regularly being attained in the majority of patients and curative secondary treatment is available, the clinically valid comparison is between strategies of overall, not just primary, treatment," he adds. "An apparently more effective initial treatment may be unattractive because of increased toxic effects."

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