We first compared the value of ABVD against BEACOPP escalated and what we found in the short term was a superiority of BEACOPP escalated in terms of progression free survival, no advantage in terms of overall survival. Now, with five more years of follow-up, we have mature data that demonstrates that there is no superiority of BEACOPP over ABVD in terms of overall survival and also the benefit in terms of progression free survival disappeared over time. This was the result of the high number of second malignancies, further malignancies, we observed in the BEACOPP arm and no second malignancies were observed in the ABVD arm. So the benefit that BEACOPP offers in terms of response rate will partially disappear over time due to the increased risk of second malignancies.

So it has been a hotly contested issue, so what would your recommendations be to doctors about treating newly diagnosed Hodgkin’s lymphoma now?

We are still at the beginning of the story because we believe that starting with ABVD could be better; now with PET interim after two courses we can better define those patients that could continue with ABVD or need to be escalated to BEACOPP. But some others, mostly in Germany, prefer to start with BEACOPP and de-escalate in case of PET negativity. So we are still discussing which is the best approach for newly diagnosed patients with Hodgkin’s lymphoma. We hope that with the advent of brentuximab vedotin in first line therapy this question would be sorted.

So for the time being, from your perspective in Italy, what position do you take for newly diagnosed disease?

Now, outside of clinical trials we continue to treat patients with ABVD.