According to a recent article published in the Journal of Clinical Oncology, the chemotherapy regimen consisting of doxorubicin (Adriamycin®), bleomycin (Blenoxane®), Velban® (vinblastine), and dacarbazine (DTIC-Dome®), referred to as ABVD, should be considered the standard chemotherapy combination as initial therapy in advanced Hodgkin’s disease.
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. Advanced Hodgkin’s disease refers to stages III or IV Hodgkin’s in which the cancer has spread from the site of origin to other sites in the body.
Two chemotherapy combinations that have proven effective and are commonly used in the treatment of Hodgkin’s are ABVD and mechlorethamine (Mustargen®), Oncovin® (vincristine), procarbazine (Matulane®), prednisone, doxorubicin, bleomycin, and Velban®(MOPP/ABV). A recent multi-institutional clinical trial was recently conducted to directly compare ABVD to MOPP/ABV as initial therapy in advanced Hodgkin’s lymphoma. This trial involved over 800 patients, approximately half of whom received ABVD and half of whom received MOPP/ABV. Five years following therapy, cancer-free survival (63% and 66%) and overall survival (82% and 81%) were nearly identical in patients treated with ABVD and MOPP/ABV, respectively. However, treatment-related deaths occurred in 25 patients treated with MOPP/ABV, compared to 15 patients treated with ABVD. In addition, there were 28 secondary cancers in patients treated with MOPP/ABV, compared to 18 in patients treated with ABVD.
These researchers have concluded that ABVD should be considered the standard initial therapy in patients with advanced Hodgkin’s disease, as cancer-free and overall survival were similar between patients treated with ABVD and MOPP/ABV, but treatment-related deaths and secondary cancers were significantly increased in patients treated with MOPP/ABV compared to ABVD. Clinical trials are ongoing to compare different chemotherapy regimens in patients with advanced Hodgkin’s disease. Patients with advanced Hodgkin’s disease may wish to speak with their physician about the risks and benefits of ABVD or the participation in a clinical trial evaluating other promising therapeutic approaches.
Reference: Duggan D, Petroni G, Johnson J, et al. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin’s disease: report of an Intergroup trial.
Journal of Clinical Oncology. 2003;21:607-614.