MADISON, WisconsinThe addition of interferon-alfa to the
COPA regimen (cyclophosphamide, 600 mg/m²; vincristine, 1.2
mg/m²; prednisone, 100 mg; and doxorubicin, 50 mg/m²)
improves survival in patients with clinically aggressive low- and
intermediate-grade non-Hodgkins lymphoma (NHL), Richard
Smalley, MD, of Synertron, Inc., said at the American Society of
Hematology meeting. He presented 10-year follow-up results of an ECOG
trial begun in 1986.
Patients with stage III or IV disease, IWF (International Working
Formulation) groups C, D, and E, and bulky or symptomatic IWF groups
A or B non-Hodgkins lymphoma all received a cycle of COPA every
28 days for 8 to 10 cycles. The 291 patients were then randomized to
receive interferon-alfa, 6 MU/m² on days 22 to 26 of each cycle
or no other therapy.
Patients who responded or were stable were followed every 2 to
4 months for relapse and annually for survival, Dr. Smalley
said. There were some dose de-escalations of the cyclophosphamide and
doxorubicin because of myelosuppression. Everyone on the study
received the full dose of prednisone and interferon-alfa. The
interferon-alfa toxicity was minimal and acceptable, he said.
Previous reports showed an overall response rate of 86% in both
treatment groups (COPA vs I-COPA). The current analysis shows that
the addition of interferon-alfa induced a prolonged time to treatment
failure, with a median of 1.9 years for the COPA group and 2.9 years
for the I-COPA group (P = .008). Survival was also better in the
I-COPA group; 7.9 years vs 5.7 years with COPA alone (P = .04).
Subset analyses showed a trend for increased survival with
interferon-alfa for both intermediatedisease and low-grade disease,
but the differences did not reach statistical significance.
There was a significant difference in time to treatment failure
favoring the interferon-alfa arm in patients with low-grade lymphoma
(IWF A, B, C) (P = .005) and in those with follicular lymphoma (IWF
B, C, D) (P = .009).
From this analysis, Dr. Smalley said, it seems that interferon-alfa
when added to COPA improves survival in patients with clinically
aggressive low-grade NHL and in D and E intermediate-grade NHL.
My conclusion is that if youre using a doxorubicin-type
regimen, interferon-alfa does improve survival, he said.