According to results recently presented at the 40th annual meeting of the American Society of Clinical Oncology, the chemotherapy regimen referred to as ABVD remains a standard of care for the chemotherapy treatment of Hodgkin’s lymphoma.
Hodgkin’s lymphoma is a cancer of the lymph system, which is part of the immune (infection fighting) system that includes blood vessels, bone marrow, lymph nodes and lymph vessels that are present throughout the body. It also includes organs such as the spleen, thymus and tonsils. This cancer is characterized by the presence of the uncontrollable growth and division of atypical white blood cells (immune cells) that crowd lymph tissue, suppressing the formation and function of other cells normally found in this tissue. Stages IIB to IV Hodgkin’s lymphoma refers to disease in which the cancer has spread from the site of origin to other sites in the body. Standard treatment for stages IIB-IV Hodgkin’s lymphoma is combination chemotherapy and/or radiation therapy. The standard chemotherapy regimen for these patients has been ABVD – doxorubicin (Adriamycin®), bleomycin (Blenoxane®), Velban® (vinblastine), and dacarbazine (DTIC-Dome®). Researchers have been comparing ABVD to other chemotherapy regimens to definitively determine the combination that produces the highest cure rates coupled with the fewest side effects.
Researchers from Italy recently conducted a clinical trial to directly compare 3 different chemotherapy regimens in the treatment of patients with stages IIB-IV Hodgkin’s lymphoma. Patients were randomized to receive either ABVD, MOPP-EBV-CAD (Nitrogen mustard, vincristine, procarbazine, prednisone, epirubicin, bleomycin, vinblastine, lomustine, melphalan, vindisine – also referred to as MEC), or the Stanford V regimen (Mustargen, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, prednisone). Patients were treated with radiation therapy if they had residual cancer following chemotherapy, or to sites of previously “bulky” cancer. At 5 years, overall survival was similar between the 3 groups (90% (ABVD) vs. 89% (MEC) vs. 83% (SV)). However, at 5 years the rate of patients who did not have cancer progression favored MEC: 89% (MEC) vs. 79% (ABVD) vs. 55% (SV). The rate of severe side effects including low levels of blood cells and infection were significantly higher in patients treated with MEC than ABVD or SV. Treatment with MEC (47%) resulted in a fewer percentage of patients having to undergo radiation therapy than ABVD (62%) or SV (66%).
The researchers concluded that, for now, ABVD should remain the standard of care as initial treatment for patients with stages IIB-IV Hodgkin’s lymphoma. Although MEC resulted in the highest proportion of patients who did not experience disease progression at 5 years, overall survival at 5 years was similar between the 3 groups of regimens, and MEC was associated with significantly higher rates of severe side effects.
Reference: Federico M, Levis A, Luminari S, et al. ABVD vs. STANFORD V (SV) vs. MOPP-EBV-CAD (MEC) in advanced Hodgkin’s lymphoma. Final results of the IIL HD 9601 randomized trial. Proceedings from the 40th annual meeting of the American Society of Clinical Oncology. New Orleans, LA. 2004. Abstract #6507.