Cancer Treatment Today

MOPP, developed in the mid 1960′s, was the first combination chemotherapy regimen for treating Hodgkin’s lymphoma (disease) with a high success rate.  It has been used alone or in combination (in part or total) with ABVD chemotherapy.  Studies over the last few years seem to indicate ABVD is just as effective with fewer long term effects.The most widely accepted regimen for HD patients with advanced stage now is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). To improve on these results, time and/or dose intensified third-line protocols were investigated. Such a protocol developed by the German Hodgkin’s Lymphoma Study Group (GHSG), BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) has been studied in various patient groups. THe results appear no better than with ABVD but also not worse.The HD9 randomized trial compared COPP/ABVD + RT with standard dose BEACOPP + RT and escalated dose BEACOPP + RT. Irradiation was given to approximately 70% of patients on all three arms based on presence of initial moderately bulky (> 5 cm) or residual nodal abnormalities. The most recent analysis, also with a median follow-up of 6.9 years, included 1195 evaluable patients and demonstrated superior freedom from treatment failure and overall survival for the patients treated with escalated dose BEACOPP + RT (Table 5).31,32 Escalated BEACOPP showed a higher but manageable rate of hematologic toxicity. Longer follow-up will be required to determine the true usefulness of escalated BEACOPP + RT. Whether the increased toxicity of this regimen (3% treatment induced mortality, 100% infertility in men, 100% infertility plus premature menopause in most women over the age of 25, increased risk of second neoplasms) can be justified remains to be determined. Of particular note is the fact that the increased efficacy of escalated BEACOPP only translated into a survival benefit in the 20% of patients with the poorest prognosis at diagnosis. The other 80% of patients with advanced Hodgkin lymphoma had the same overall survival whether initially treated with ABVD or escalated BEACOPP because of the availability of effective secondary treatment with high-dose chemotherapy and stem cell transplantation.

Das P, Ng A, Constine LS, Hodgson DC, Mendenhall NP, Morris DE, Yunes MJ, Chauvenet AR, Friedberg JE, Hudson MM, Winter JN, Expert Panel on Radiation Oncology-Hodgkin's Lymphoma. ACR Appropriateness Criteria® Hodgkin's lymphoma--favorable prognosis stage I and II. [online publication]. Reston (VA): American College of Radiology (ACR); 2008. 14 p. [53 references]