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Treatment of patients with advanced or bulky Hodgkin disease with a 12‐week doxorubicin, bleomycin, vinblastine, and dacarbazine‐like chemotherapy regimen followed by extended‐field, full‐dose radiotherapy
Author(s) -
Djeridane Malika,
Oudard Stéphane,
EscoffreBarbe Martine,
LacotteThierry Laurence,
Desablens Bernard,
Briére Jean,
Dib Mamoun,
Cassasus Philippe,
Ghandour Christiane,
Lamy Thierry,
Lejeune Françoise,
Simon Marc,
Traullé Catherine,
Vigier Magda,
Maisonneuve Henri,
Briére Josette,
Colonna Pierre,
Andrieu JeanMarie
Publication year - 2002
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/cncr.10932
Subject(s) - medicine , nodular sclerosis , vincristine , regimen , dacarbazine , chemotherapy , etoposide , vinblastine , surgery , cyclophosphamide , procarbazine , radiation therapy , gastroenterology , lymphoma , hodgkin lymphoma
BACKGROUND This Phase II study was performed in patients with advanced or bulky Hodgkin disease (HD) to evaluate the results of a 7‐drug chemotherapy (CT) regimen that was administered over 12 weeks according to 2 randomized modalities followed by high‐dose lymph node irradiation. METHODS From 1990 to 1996, 162 patients with HD at clinical stages (CS) I–III with bulky disease (mediastinal mass ratio ≥ 0.45 and/or unilateral or bilateral pelvic plus lumboaortic disease; 86 patients) or CS IV (76 patients) were randomized to receive the same cumulated dose of a CT regimen consisting of epirubicin (240 mg/m 2 ), bleomycin (60 mg/m 2 ), vinblastine (20 mg/m 2 ), vincristine (4 mg/m 2 ), cyclophosphamide (4000 mg/m 2 ), etoposide (900 mg/m 2 ), and methotrexate (180 mg/m 2 ) plus methylprednisolone (1500 mg/m 2 ) over 12 weeks either every 4 weeks (Arm Y, 79 patients) or every 3 weeks (Arm Z, 83 patients). Patients with disease in complete remission (CR) or partial remission after CT received extended‐field lymph node irradiation (involved areas, 40 grays [Gy]; noninvolved areas, 30 Gy). RESULTS Forty‐two percent of patients achieved a post‐CT CR, and 86% of patients achieved a CR after the completion of irradiation (there was no difference between Arm Y and Arm Z). Thirty‐five patients developed recurrent disease; most of those patients were in post‐CT partial remission. The 10‐year freedom from first progression rate was 63.9% (there was no difference between Arm Y and Arm Z). Thirty‐eight patients died: 24 patients from HD, 3 patients from CT‐related early sepsis, 1 patient from radiation‐induced pneumonitis, 6 patients from a second malignancy, and 4 patients from causes unrelated to treatment. The overall 10‐year survival rate was 76.7%. Survival was slightly higher among patients in Arm Y (83.3%) compared with patients in Arm Z (70.2%; P = 0.12). CONCLUSIONS No differences were found when the same amount of CT was delivered in three courses or in four courses. In 1997, because most recurrences of the H90‐A/B trial occurred in patients who achieved a post‐CT partial remission, the authors decided to reinforce the intensity of the initial CT and designed a new randomized study comparing two modalities of more intensive CT plus consolidative radiotherapy (H97‐LM trial). Cancer 2002;95:2169–79. © 2002 American Cancer Society. DOI 10.1002/cncr.10932