Randomized trial of CVPP for three versus six cycles in favorable-prognosis and CVPP versus AOPE plus radiotherapy in intermediate-prognosis untreated Hodgkin's disease.

Pavlovsky, Santiago; Schvartzman, Enrique; Lastiri, Francisco; Magnasco, H; Corrado, Claudia; Raslawski, Elsa; Cancela, M E; Ardaiz, MC; Cerutti, Ider; Rosso, Alberto; Bruno, Stefania; Aranguren, Pedro Negri; Salvarezza, A.; Donato, Hugo; Dibar, E; Zirone, Sandra

doi:10.1200/jco.1997.15.7.2652

Cited by 30 publications

(7 citation statements)

References 18 publications

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“…Indirect evidence supporting the presence of two different prognostic subgroups also comes from other studies. 2,3 To summarize, dividing the early stages into two distinct subgroups is strongly supported by these data.…”

Section: Should One Distinguish Between Early Favorable and Early Unfsupporting

confidence: 50%

The Past: What We Have Learned in the Last Decade

Borchmann

Engert

2010

Hematology

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Hodgkin lymphoma (HL) has become a curable malignancy for most patients during the last decades. However, many controversies still exist on the optimal strategy of how to cure our patients. The key question is how to balance the risks and toxicities of chemotherapy and radiotherapy against the need for a definite treatment for early or advanced-stage HL patients. However, although many studies have been conducted and reported during the past decade, interpretation of their results and treatment recommendations might vary significantly in different countries. For example, early-stage HL might be divided into two different subgroups: early favorable and early unfavorable or not. Treatment of early-stage HL might include radiotherapy ("combined modality") or not. Depending on the extent of radiotherapy, the schedule and number of chemotherapy cycles are also questioned. For advanced-stage HL, the situation is not much different. Compared with ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine), the more aggressive escalated BEACOPP regimen (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) is highly effective, but also raises concern due to excessive toxicity. Thus, there is a controversy about the standard of care for advanced HL patients. Because no mature results comparing these approaches with each other are currently available, it remains our duty to share the preliminary information with our patients and to figure out the most appropriate individual treatment strategy. Of course, the discussion of these issues is influenced by experiences and preferences. In contrast, in this article, we will try to focus on the available scientific evidence regarding the first-line treatment of HL. Of course, focusing on the last decade necessarily exclude the most recent results from ongoing studies. Thus, even though this article comprises treatment recommendations for HL patients, the best treatment certainly still is within properly designed prospective clinical trials.

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Section: Should One Distinguish Between Early Favorable and Early Unfsupporting

confidence: 50%

The Past: What We Have Learned in the Last Decade

Borchmann

Engert

2010

Hematology

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“…This suggests that early stages of Hodgkin disease in children can be treated with less than 6 courses of CVPP. Only a few studies are available to support the use of chemotherapy on it's own [24,[27][28][29][30][31][32][33][34]. There have been no reported children series treated with chemotherapy alone in the United States.…”

Section: Discussionmentioning

confidence: 99%

Hodgkin disease in children: Results of a prospective randomized trial in a single institution in Argentina

Sackmann‐Muriel¹,

Zubizarreta²,

Gallo³

et al. 1997

Med. Pediatr. Oncol.

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“…The validity of this combination has been shown by several groups [50][51][52] and most recently by the 3-year FFS results of a large randomized trial comparing in early HD (supradiaphragmatic CS IA or IIA with a MMR Ͻ 0.33) 3 courses of Adriamycin plus vinblastine combined with subtotal RT (EFS, 94%) versus subtotal RT alone (EFS, 81%, P ϭ .001). 53 Three-year EFS rates of our H90-NM study for patients with similar characteristics were the following: arm A, 95%; arm E, 90% (P ϭ NS).…”

Section: Discussionmentioning

confidence: 99%

Three cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or epirubicin, bleomycin, vinblastine, and methotrexate (EBVM) plus extended field radiation therapy in early and intermediate Hodgkin disease: 10-year results of a randomized trial

Maignan

Desablens²,

Delwail³

et al. 2004

Blood

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From 1990 to 1996, a total of 386 adult patients with early/intermediate Hodgkin disease (HD) were randomly assigned to receive 3 cycles of adriamycin, bleomycin, vinblastine, dacarbazine (an alkylating agent), and methylprednisolone (ABVDm, arm A) or epirubicin, bleomycin, vinblastine, methotrexate, and methylprednisolone (EBVMm, arm E), a combination without alkylating agent. Responding patients received extended field radiation therapy (RT). Postchemotherapy complete remission and 10-year freedom from progression rates were higher in arm A (79.5% and 91.4%) than in arm E (70.4%, P ‫؍‬ .04, and 80%, P < .002). HD mortality (HDM), treatment-related mortality (TRM), and overall survival (OS) were similar in both arms (A, 2.1%, 7.5%, and 90.4%; B, 3.9%, 5.5%, and 90.3%). However TRM and OS rates were lower in patients aged 40 years or older (P < .005), reflecting the increasing incidence of background fatal events with increasing age. Finally, event-free survival (EFS) was higher in arm A (84.6%) than in arm E (74.9%, P < .02).

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Randomized trial of CVPP for three versus six cycles in favorable-prognosis and CVPP versus AOPE plus radiotherapy in intermediate-prognosis untreated Hodgkin's disease.

Abstract: Three cycles of CVPP without RT are equally effective as six cycles in the favorable-risk group. However, in the intermediate-group, CVPP plus RT is superior to AOPE plus RT, with significantly fewer events before and after induction (P = .009), without a difference in overall survival.

Cited by 30 publications

References 18 publications

The Past: What We Have Learned in the Last Decade

The Past: What We Have Learned in the Last Decade

Hodgkin disease in children: Results of a prospective randomized trial in a single institution in Argentina

Three cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or epirubicin, bleomycin, vinblastine, and methotrexate (EBVM) plus extended field radiation therapy in early and intermediate Hodgkin disease: 10-year results of a randomized trial

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