Commentary on Abstract #2567

Publication
Article
OncologyONCOLOGY Vol 13 No 3
Volume 13
Issue 3

The CHOP (cyclophosphamide, doxorubicin, Oncovin, and prednisone) regimen has been the standard approach to patients with advanced-stage intermediate-grade non-Hodgkin’s lymphoma (NHL) for more than 20 years.A randomized comparison between CHOP, m-BACOD (methotrexate, bleomycin, Adriamycin, cyclophosphamide, Oncovin, and dexamethasone).

The CHOP (cyclophosphamide, doxorubicin, Oncovin, and prednisone) regimen has been the standard approach to patients with advanced-stage intermediate-grade non-Hodgkin’s lymphoma (NHL) for more than 20 years.A randomized comparison between CHOP, m-BACOD (methotrexate, bleomycin, Adriamycin, cyclophosphamide, Oncovin, and dexamethasone),

ProMACE/CytaBOM (prednisone, methotrexate, Adriamycin, cyclophosphamide, etoposide, cytarabine, bleomycin, and Oncovin), and MACOP-B (methotrexate, Adriamycin, cyclophosphamide, Oncovin, prednisone, and bleomycin) failed to show any advantage for the more intensive regimens. Moreover, CHOP was less expensive and had a lower mortality than the other programs (Fisher et al: N Engl J Med 328:1002-1006, 1993). Nevertheless, only 30% to 40% of patients are cured with this regimen.

Using the International Prognostic Index (IPI), Shipp et al determined that the likelihood of cure correlates with a number of clinical factors: age, stage, lactic dehydrogenase (LDH) level, performance status, and number of extranodal sites (Shipp et al: N Engl J Med 329:987-994, 1993). They found that patients ³ 60 years of age have a particularly poor outlook with aggressive chemotherapy regimens, such as CHOP. Their poor outcome may be related, in part, to a lower delivered dose of chemotherapy.

Zinzani et al reported the favorable experience of the Italian Cooperative Study Group (abstract #2567) using VNCOP-B (vincristine, Novantrone, cyclophosphamide, etoposide, bleomycin, and prednisone) as initial treatment in elderly patients with high-grade NHL.

Single-arm studies of chemotherapy regimens, no matter how promising, should be interpreted with caution, as subsequent randomized trials have uniformly failed to confirm these leads. The practice of developing regimens based on minor modifications of dose and schedule of conventional agents should be discouraged. More innovative strategies are obviously needed.

Articles in this issue

WHO Declares Lymphatic Mapping to Be the Standard of Care for Melanoma
Rituximab: Phase II Retreatment Study in Patients With Low-Grade or Follicular Non-Hodgkin’s Lymphoma
Response Criteria for NHL: Importance of “Normal” Lymph Node Size and Correlations With Response
Chemotherapy Plus Radiation Improves Survival in Patients With Cervical Cancer
A Randomized Trial of Fludarabine, Mitoxantrone (FM) Versus Doxorubicin, Cyclophosphamide, Vindesine, Prednisone (CHEP) as First Line Treatment in Patients With Advanced Low-Grade Non-Hodgkin's Lymphoma: A Multicenter Study by GOELAMS Group
Navelbine Increased Elderly Lung Cancer Patients’ Survival
Fludarabine Versus Conventional CVP Chemotherapy in Newly C Diagnosed Patients With Stages III and IV Low-Grade Malignant Non-Hodgkin’s Lymphoma: Preliminary Results From a Prospective, Randomized Phase III Clinical Trial in 381 Patients
Multicenter, Phase III Study of Iodine-131 Tositumomab (Anti-B1 Antibody) for Chemotherapy-Refractory Low-Grade or Transformed Low-Grade Non-Hodgkin’s Lymphoma
T-Cell–Depleted Allogeneic Bone Marrow Transplant From HLA-Matched Sibling Donors for Non-Hodgkin’s Lymphoma
Consensus Statement on Prevention and Early Diagnosis of Lung Cancer
In Vivo Purging and Adjuvant Immunotherapy With Rituximab During PBSC Transplant For NHL
Fludarabine and Cyclophosphamide: A Highly Active and Well-Tolerated Regimen for Patients With Previously Untreated Indolent Lymphomas
Campath-1H Monoclonal Antibody in Therapy for Advanced Low-Grade Non-Hodgkin’s Lymphomas: A Phase II Study
AIDS Drugs Effective Against Most Common HIV Strain
Rituximab Therapy in Previously Treated Waldenström’s Macroglobulinemia: Preliminary Evidence of Activity
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