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A randomized comparison of the efficacy and toxicity of epirubicin and doxorubicin in the treatment of patients with non‐hodgkin's lymphoma
Author(s) -
Nair Reena,
Ramakrishnan Gopal,
Nair Narendran N.,
Saikia Tapan K.,
Parikh Purvish M.,
Joshi Sandhaya R.,
Soman Chitralekha S.,
Mukhadan Maryann,
Dinshaw Ketayun T.,
Advani Suresh H.
Publication year - 1998
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19980601)82:11<2282::aid-cncr26>3.0.co;2-p
Subject(s) - medicine , epirubicin , anthracycline , mucositis , vincristine , doxorubicin , regimen , cardiotoxicity , chemotherapy , gastroenterology , surgery , cyclophosphamide , cancer , breast cancer
BACKGROUND Combination chemotherapy consisting of methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisolone, and bleomycin (MACOP‐B) has been frequently used for the treatment of non‐Hodgkin's lymphoma. This randomized study was undertaken to assess the efficacy and toxicity of this regimen when either doxorubicin or epirubicin was used as the anthracycline drug. METHODS Between April 1989 and December 1993, 211 previously untreated patients with intermediate grade and high grade non‐Hodgkin's lymphoma were randomized to receive either doxorubicin (n = 106) or epirubicin (n = 105) with the MACOP‐B regimen. These patients were followed through December 1996. Numerous clinical features predictive of response and survival were analyzed. Cardiac and noncardiac toxicity in the two treatment arms were compared. RESULTS The median age of the patients was 48 years. Complete remission was experienced by 122 patients (58.3%); 62 patients (58.5%) achieved complete remission in the doxorubicin arm and 60 (58.1%) in the epirubicin arm. Response rates, time to treatment failure, relapse data, and overall survival were comparable between the two arms. Morbidity due to mucositis, vomiting, peripheral neuropathy, and cardiotoxicity were also comparable. The overall mortality was 10%. Mortality due to neutropenic sepsis was considerably higher among patients who received epirubicin (10 patients) than among those who received doxorubicin (5 patients). Cardiac evaluation revealed no difference in toxicity between the two arms. CONCLUSIONS Epirubicin was as effective as doxorubicin in terms of patients' responses to therapy. There was no difference in cardiotoxicity between the two treatment arms. However, in this study, the mortality due to neutropenic sepsis was significantly higher among patients treated with epirubicin. Cancer 1998;82:2282‐2288. © 1998 American Cancer Society.