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Patterns of Chemotherapy Administration in Patients With Intermediate-Grade Non-Hodgkin’s Lymphoma

Patterns of Chemotherapy Administration in Patients With Intermediate-Grade Non-Hodgkin’s Lymphoma

In their article, Picozzi et al
describe how patients with aggressive lymphoma were treated in various community
practice centers between 1993 and 1998, and they compare that treatment to
"standard treatment." Their main conclusion is that more than 40% of
these patients did not receive adequate treatment as defined by today’s
standards. The authors attempt to analyze why the physician in charge altered
the referenced treatment.

Which Regimen for Patients With Aggressive Lymphoma?

Inadequate choice of therapy was the most common explanation
for substandard treatment of these patients, according to the authors. Only 65%
were treated with the CHOP regimen (cyclophosphamide [Cytoxan, Neosar],
doxorubicin HCl, vincristine [Oncovin], prednisone), 10% were treated with CNOP
(cyclophosphamide, mitoxantrone [Novantrone], vincristine, prednisone), 11%
received another regimen containing doxorubicin, and 14% received a regimen
without doxorubicin.

The reasons guiding these choices, however, were not entirely
clear to the authors: The only correlation they found was that patients treated
with CNOP tended to be older. Nevertheless, if the CHOP regimen cures only
approximately 35% of patients with diffuse large-cell lymphoma but offers better
or similar efficacy than other treatments with lower toxicity, it should be
recommended.[1]

CNOP was used in the hope of decreasing doxorubicin toxicity
in elderly patients, although in randomized studies CNOP was associated with a
lower survival and a higher toxicity than CHOP.[2] Among the more than 50 phase
II or phase III trials conducted in elderly patients, none demonstrated a better
efficacy/toxicity ratio than that seen with the CHOP regimen.[3,4] Such a
benefit was demonstrated only recently for the combination of rituximab (Rituxan)
and CHOP.[5]

Cooperative groups have expended much effort in seeking a
more efficacious regimen than CHOP, and these efforts must continue. However,
until randomized studies demonstrate the superiority of one regimen over
another, patients with an aggressive lymphoma who are not enrolled in a clinical
trial should adhere to standard treatment with CHOP (or, for diffuse large-cell
lymphoma, CHOP in combination with rituximab).

How Many Cycles of CHOP?

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