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(Drug information on bleomycin), vinblastine(Drug information on vinblastine), dacarbazine(Drug information on 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.
