The aging of the population and the increased incidence of non-Hodgkin’s lymphoma will result in a large number of elderly patients with lymphoma. Newer therapies will be required for this group of patients. One common modification is substituting Novantrone for Doxorubicin in the standard CHOP or R-CHOP regimen. This produces less cardiotoxicity, which is a particular problem for the elderly.
Mitoxantrone was evaluated in combination with other agents for the treatment of NHL. A total of 28 patients were treated with different regimens. A first-line comparative trial of the combination of intermediate dose methotrexate with leucovorin rescue + bleomycin + doxorubicin + cyclophosphamide + vincristine + dexamethasone (m-BACOD) versus the same combination with 10 mg/mmitoxantrone replacing doxorubicin (m-BNCOD) has shown activity: 4 PR’s in 6 evaluable patients with m-BNCOD and 3 PR’s in 6 with m-BACOD. The combination of mitoxantrone at 10 mg/m daily for 3 days, + vincristine + dexamethasone (NOD) produced 3 PR’s in 5 evaluable patients. A first-line comparative trial of the combination of cyclophosphamide + vincristine + prednisone + doxorubicin (CHOP) versus the same combinations with 10 mg/mmitoxantrone replacing doxorubicin (CNOP) showed equivalence.
R-CHOP is now standard of care for diffuse large cell lymphomas and follcular lymphomas. The substituion with Novantrone is supported by a randomized study referenced below. These dose-reduced regimens can be given with nearly 100% dose intensity with 65% of patients completing all the treatment. Survival is comparable to that observed with the more intensive regimens given in this age group, such as MACOP.
Bessell EM, Burton A, Haynes AP, Glaholm J, Child JA, Cullen MH, Davies JM, Smith GM, Ellis IO, Jack A, Jones EL; Central Lymphoma Group UK.A randomised multicentre trial of modified CHOP versus MCOP in patients aged 65 years and over with aggressive non-Hodgkin’s lymphoma.Ann Oncol. 2003 Feb;14(2):258-67.