Is escalated BEACOPP dead? Rethinking standards in hodgkin lymphoma treatment

Escalated BEACOPP has long been a key component in the treatment of Hodgkin lymphoma, offering significant survival benefits in both early and advanced stages. However, its use comes with considerable drawbacks, including heightened toxicity, infertility, and an increased risk of secondary malignancies. The emergence of novel therapies, such as Brentuximab Vedotin-an anti-CD30 antibody-drug conjugate-and immune checkpoint inhibitors like Nivolumab and Pembrolizumab, has begun to redefine the treatment landscape. These advancements provide comparable or superior efficacy while significantly reducing toxicity. This article examines the gradual decline of escalated BEACOPP in Hodgkin lymphoma treatment, highlighting recent clinical trial data and evolving therapy protocols that are shifting treatment paradigms. Additionally, it explores updates in international guidelines reflecting these changes. Despite the promise of newer therapies, their widespread adoption presents challenges, including accessibility, cost, and long-term efficacy considerations. This review discusses these hurdles while looking ahead to future directions in Hodgkin lymphoma management.