Dose Intensification

The GELA recently published results of a multicenter prospective phase III study comparing CHOP to a second-generation regimen that was initiated in 19 9 3.42 Over 600 older patients were randomized to either ACVBP (intensified doxorubicin, intensified cyclophosphamide, vindesine, bleomycin, pred-nisone, intrathecal methotrexate) or standard CHOP treatment. All patients received growth factor prophylaxis. The complete remission rates did not differ between the two groups, and ACVBP was associated with a significant increase in hematologic and non-hematologic toxicity and treatment-related deaths. But with a median follow-up of 68 months, the ACVBP patients had a longer EFS (39% vs 29%, p = 0.005), longer disease-free survival (62% vs 44%, p = 0.0002), and an improvement in OS (46% vs 38%, p = 0.036) at 5 years. This study was conducted at the same time as the influential, but negative, SWOG randomized study comparing CHOP to second-generation regimens. Explanations for these discrepant results include the possibility that the ACVBP regimen is superior to the investigational regimens tested in the SWOG study, or that patient selection was more geared to patients with advanced disease in the GELA study.

0 0

Post a comment