VIENNA--The first Hodgkin's disease study updates to come out of the
Milan Cancer Institute since 1989 have now confirmed that the therapeutic
advantages of regimens containing ABVD (Adriamycin, bleomycin, vinblastine,
dacarbazine) are sustained for nearly two decades.
"Compared to MOPP, the fraction of patients alive and in continuous
complete remission following ABVD or MOPP/ABVD was significantly superior,"
Dr. Valeria Bonfante reported at the 21st Congress of the European Society
for Medical Oncology (ESMO).
Among patients with stage IIB or III Hodgkin's disease who had been
randomized in the late 1970s to receive ABVD followed by radiotherapy and
then a second course of ABVD, 18-year freedom from progression was 77%
and freedom from tumor mortality was 86%.
In contrast, only 60% of patients assigned to MOPP and radiotherapy
were free from progression (P = .002), and 67% were free from tumor mortality
(P = .002). The difference in overall survival at 18 years, while still
favoring ABVD, no longer reached significance.
In patients with stage IV Hodgkin's disease, freedom from progression
after 18 years was 61% for patients treated with alternating MOPP/ABVD,
compared with 30% for those who received MOPP alone (P = .002). Freedom
from tumor mortality was likewise higher among MOPP/ABVD-treated patients
than among MOPP-treated subjects (77% versus 53%, P = .05).
Despite the failure of the overall survival difference to achieve statistical
significance, Dr. Bonfante said, "the results still confirmed the
superiority of the alternating program versus MOPP alone."
The top cause of death was progressive Hodgkin's disease, trailed by
second malignancy. The cumulative incidence of second malignancies was
10% with MOPP-containing regimens and 14% with ABVD-containing regimens,
with the relative risk greatest in older patients. The fact that second
malignancies developed anywhere from 1 to 16 years after treatment underscores
the need for continuous surveillance of survivors.