Classically, Hodgkin lymphoma (cHL) is highly treatable, yet its treatment for advanced stages is invariably hard to optimize. Long considered one of the cornerstones in the management of advanced-stage Hodgkin lymphoma, the BEACOPP regimen, which consists of vincristine, procarbazine, doxorubicin, bleomycin, etoposide, cyclophosphamide, and prednisone, has a high toxicity profile that often limits its use. A new combination regimen is BrECADD, which comprises brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone.

This recently developed regimen proved more effective and tolerable.

Components of BrECADD

The BrECADD regimen adds brentuximab vedotin, an anti-CD30 antibody-drug conjugate, to a chemotherapy backbone. This agent selectively kills CD30-expressing Hodgkin Reed-Sternberg cells with high specificity, sparing normal tissues and reducing systemic toxicity. The remaining components of the regimen—etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone—function in synergy to augment cytotoxicity while minimizing overlapping adverse events.

Efficacy Comparison

BrECADD vs. BEACOPP

Clinical trials and real-world data underscore the superior efficacy of BrECADD over BEACOPP in advanced-stage cHL:

Higher Response Rates: Studies report that BrECADD achieves higher complete response (CR) rates compared to BEACOPP. The incorporation of brentuximab vedotin targets CD30 with precision, leading to improved eradication of malignant cells.

Progression-Free Survival (PFS): BrECADD demonstrates superior PFS, reducing the likelihood of disease recurrence. Long-term follow-ups indicate sustained remission in a significant proportion of patients treated with BrECADD.

Improved Overall Survival (OS): While BEACOPP has historically been effective, the lower toxicity and enhanced efficacy of BrECADD translate into better OS outcomes for patients.

Tolerability and Safety Profile

A critical advantage of BrECADD lies in its improved tolerability. BEACOPP is associated with significant acute and long-term toxicities, including myelosuppression, infertility, and secondary malignancies. In contrast, BrECADD offers:

Reduced Hematologic Toxicity: Lower rates of neutropenia and anemia have been observed with BrECADD, minimizing the need for growth factor support or transfusions.

Less Neuropathy: Although brentuximab vedotin can cause peripheral neuropathy, dose adjustments and careful monitoring mitigate this risk, making it more manageable than the cumulative neurotoxicity seen with vincristine in BEACOPP.

Improved Quality of Life: Patients on BrECADD report better overall well-being, with fewer interruptions to daily activities and work.

Practical Considerations

The transition to BrECADD as a standard of care for advanced-stage cHL involves several considerations:

Cost: Brentuximab vedotin is a costly agent, potentially limiting access in some healthcare settings. However, the reduced need for supportive care and long-term management of toxicities may offset initial expenses.

Monitoring: Regular monitoring for brentuximab vedotin-induced neuropathy and other potential side effects is essential to optimize outcomes.

Individualized Treatment: For patients with contraindications to specific agents within BrECADD, modified regimens may be required.

Conclusion

The BrECADD regimen represents a significant advancement in the treatment of advanced-stage classical Hodgkin lymphoma. By combining the targeted efficacy of brentuximab vedotin with a chemotherapy backbone, BrECADD achieves superior outcomes with reduced toxicity compared to the traditional BEACOPP regimen. As clinical practice continues to evolve, BrECADD stands as a promising standard for improving survival and quality of life for patients with this challenging disease.