LUGANO, SwitzerlandIn 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(Drug information on etoposide)-containing chemotherapy regimen alongside the current world standard of ABVD (Adriamycin, bleomycin(Drug information on bleomycin), vinblastine(Drug information on vinblastine), dacarbazine(Drug information on 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(Drug information on procarbazine), prednisone(Drug information on prednisone)) on a 42-day cycle, or the etoposide-containing regimen, which included chlorambucil(Drug information on chlorambucil), vinblastine, procarbazine and prednisolone(Drug information on 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(Drug information on 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.