Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
CHEMOTHERAPY OF HODGKIN'S DISEASE
PPO Updates; 2(8):1-12 1988. Unique Identifier : AIDSLINE ICDB/89650160 Wiernik PH; Albert Einstein Cancer Center and Montefiore Medical Center, New; York, NY
Abstract:
Long-term observations of Hodgkin's disease (HD) patients (pts) who had advanced disease and who were treated with the MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) combination chemotherapy (CT) regimen at the NCI demonstrated that the majority of the pts were cured by such treatment. These findings led to additional studies the results of which suggested that the MOPP is also a highly effective initial therapy for early-stage HD. Newer CT regimens developed since the MOPP program can be grouped into those utilizing drugs similar to those in the MOPP regimen but with a different collective spectrum of toxicity and into those with truly different agents; the most widely studied regimen in the latter group is the ABVD regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine). There is some evidence that newer regimens such as ABVD may be more therapeutic than MOPP and its variants. Achievement of cure in most HD pts presented the opportunity to study long-term complications of cure, which have now been defined in great detail; successful treatment of such complications, or prevention of them, is the final frontier in the therapy of HD and one to which significant effort has recently been directed. An update on aspects of CT of HD is presented in this review under the following section headings and subheadings: treatment of advanced disease (single-agent therapy and early combinations, modern combination CT, first generation MOPP variants, second generation MOPP variants, third generation MOPP variants, new regimens, new concepts, bone marrow transplantation, wide-field radiation therapy alone for relapse after CT), treatment of early stage disease (combined modality therapy, treatment of Stage IIIA, CT alone for early-stage disease), special problems (subdiaphragmatic early stage disease, HD in childhood and adolescence, HD in AIDS and AIDS-related complex, gonadal dysfunction, histology, second neoplasms), and summary. The vast majority of HD pts are cured with present-day therapy; combination CT is the treatment of choice for pts with advanced disease. The choice of regimen appears to be less important than dose intensity in determining outcome. Recent data suggest that it may be easier to achieve adequate intensity of dose with the ABVD regimen than with the MOPP regimen, due to the lower toxicity associated with the ABVD. There is little support at present for the concept of alternating noncross-resistant regimens, but several important studies testing the concept have not yet been completed. Combination CT may be as effective initially as extended field radiotherapy for early stage disease, but the relative long-term merits of the two modalities are still to be determined. Combined modality therapy is superior to either radiotherapy or CT alone for pts with bulky disease, especially in the mediastinum. (116 Refs)
Keywords: Adolescence Adult Antineoplastic Agents, Combined/ADVERSE EFFECTS/*THERAPEUTIC USE Bleomycin/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Child Clinical Trials Combined Modality Therapy Dacarbazine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Doxorubicin/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Female Hodgkin's Disease/*DRUG THERAPY/MORTALITY/PATHOLOGY/RADIOTHERAPY Human Infertility, Female/CHEMICALLY INDUCED Infertility, Male/CHEMICALLY INDUCED Leukemia/CHEMICALLY INDUCED Male Mechlorethamine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Neoplasm Staging Neoplasms, Radiation-Induced Prednisone/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Procarbazine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Prognosis Recurrence Risk Factors Vincristine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS CLINICAL TRIAL JOURNAL ARTICLE REVIEW REVIEW LITERATURE
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Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
