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New Chemo Regimen Best for Lymphoma

Beat out traditional chemo followed by radiation, study authors report

WEDNESDAY, March 23, 2005 (HealthDay News) -- A new chemotherapy combination is more effective at treating aggressive non-Hodgkin's lymphoma than three cycles of chemotherapy plus radiation, French researchers have found.

Patients taking higher doses of doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) followed by etoposide and ifosfamide showed an estimated 90 percent five-year survival rate, compared to an 81 percent survival rate for patients receiving three cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) followed by radiation.

Additionally, the study authors noted that since the research was undertaken, a new medication called rituximab was approved for use in the treatment of non-Hodgkin's lymphoma, and that adding this medication to the ACVBP regimen could make it even more effective.

The study appears in the March 24 issue of the New England Journal of Medicine.

"Treatment by combined CHOP-radiotherapy has been standard for aggressive large-cell lymphoma with localized stage I and II disease. The present study shows that the outcome of such patients is improved with chemotherapy alone without adjuvant radiotherapy," said study author Dr. Felix Reyes, head of clinical hematology at the Hopital Henri Mondor in Paris.

"Radiotherapy is no more mandatory for treatment of localized aggressive lymphoma," he said, because chemotherapy is becoming more effective.

Not everyone agrees that it's time to give up radiation just yet, however. Dr. Jay Brooks, chairman of hematology and oncology at the Ochsner Clinic Foundation in New Orleans, said that while this study was very well done, the researchers didn't compare ACVBP to the standard American treatment, which is four cycles of CHOP and rituximab, followed by radiation.

"This study clearly shows that the new regimen is better than three cycles of CHOP," said Brooks, but it doesn't answer the question of whether it's better than four.

Brooks also noted the study population was small, and because of the time period included in the study, the researchers weren't able to include rituximab. Because of these factors, he said, he wouldn't be making any changes to the way he treats his patients based on this one study.

Non-Hodgkin's lymphoma is cancer that occurs in part of the immune system, such as the lymph nodes or spleen. It affects about three in every 10,000 people, mainly those over 50, according to the National Institutes of Health.

In the study, Reyes and his colleagues compared 329 people receiving CHOP plus radiation, to 318 patients receiving ACVBP and then two additional medications. All of the study volunteers were under the age of 61 and had stage I or II, local, aggressive non-Hodgkin's lymphoma. The average time patients were followed was 7.7 years.

The researchers found the ACVBP regimen with no radiation outperformed CHOP with radiation. The estimated five-year, event-free survival rate was 82 percent for the ACVBP group, compared to 74 percent for the CHOP group. Overall five-year survival rates were estimated to be 90 percent for the ACVBP group and 81 percent for the CHOP group.

Reyes said he thinks ACVBP bested CHOP plus radiation for several reasons, including the fact that doctors used higher doses of some of the medications in ACVBP.

Reyes and his colleagues are now studying the addition of rituximab to ACVBP to see if this combination is even more effective, he said.

The one group of people who shouldn't receive ACVBP, according to Reyes, is the elderly. He said this regimen has side effects that can be hard to control in people older than 60 to 65. CHOP plus rituximab is a good option for these people, he added.

More information

The National Cancer Institute offers more information about treating non-Hodgkin's lymphoma.

SOURCES: Felix Reyes, M.D., head, clinical hematology, Hopital Henri Mondor, Paris; Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Clinic Foundation Hospital, New Orleans; March 24, 2005, New England Journal of Medicine
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