LUGANO, Switzerland—In previously untreated, advanced Hodgkin’s disease, the ChIVPP/EVA regimen, though associated with risk of sterility, is
highly effective with a low incidence of secondary leukemias, according to a
recent analysis of two randomized studies.

The studies, both of which include a large number of patients with long
follow-up, hint at the potential role for this more intensive, etoposide-containing
chemotherapy regimen alongside the current world standard of ABVD (Adriamycin,
bleomycin, vinblastine, dacarbazine), according to Dr. John A. Radford,
professor of medical oncology, Christie Hospital, Manchester, UK.

"It would be wrong to say that one particular treatment is the
treatment for advanced Hodgkin’s disease," Dr. Radford said. "I
think there will be a portfolio of therapies that will be used to try to match
therapy to illness more closely, and I think this is something that is going to
develop over the next few years."

At the 8th International Conference on Malignant Lymphoma (ICML abstract
207), Dr. Radford presented an analysis of two consecutive randomized trials of
ChIVPP/EVA vs a comparator. The trials included 701 patients with previously
untreated stage III/IV Hodgkin’s disease.

In the first trial, initiated in 1984, 419 patients received either the
then-standard MVPP regimen (mechlorethamine, vinblastine, procarbazine,
prednisone) on a 42-day cycle, or the etoposide-containing regimen, which
included chlorambucil, vinblastine, procarbazine and prednisolone (ChIVPP)
orally on days 1 to 7, followed by etoposide, vincristine, and Adriamycin (EVA)
on day 8 of a 28-day cycle. Treatments were given for 6 to 8 cycles.

Results, published in 1995 in the Journal of Clinical Oncology (Radford JA
et al: 13:2379-2385, 1995), showed that ChIVPP/EVA-treated patients had
superior freedom from progression, event-free survival, and overall survival,
with fewer secondary cases of acute myelogeous leukemia (AML) or
myelodysplastic syndrome (2 cases vs 8 for MVPP) with a median follow-up of
12.5 years.

The second trial compared 11 weeks of VAPEC-B chemotherapy (vincristine,
Adriamycin, prednisolone, etoposide, cyclophosphamide, bleomycin) with 6 months
of ChIVPP/EVA in 282 patients enrolled beginning in 1992. The goal was to
determine whether the VAPEC-B regimen, shorter and with relatively low
toxicity, was at least as effective as ChIVPP/EVA chemotherapy.