New Drug Regimen Helps Hodgkin's Disease

High doses of seven drugs work best, study finds

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WEDNESDAY, June 11, 2003 (HealthDayNews) -- Various alphabet soups of cancer drugs are used to treat advanced Hodgkin's disease, a form of blood-related cancer that strikes the lymph system. But which combination of medicines works best hasn't been clear.

A new German study helps answer the question. It found better survival rates and more remissions on a new drug regimen than on an older therapy or on a less-potent version of the new treatment.

The new regimen, high doses of seven drugs known by the initials BEACOPP, had a five-year survival rate of 91 percent, several points better than the next most effective alternative. The drugs attack Hodgkin's disease in a variety of ways, from damaging DNA in cancerous cells to suppressing the formation of those cells in the first place.

The regimen does have a few drawbacks: It's hard to tolerate and administer; it's costly; and, more significantly, it has a propensity to cause other blood cancers. Still, the researchers say those cancers are usually manageable and the treatment's overall effectiveness outweighs its downside.

Dr. James Armitage, a lymphoma expert and dean of the University of Nebraska's College of Medicine, calls the study "provocative." Although the researchers compared BEACOPP to a treatment, called COPP-ABVD, that's outmoded by U.S. standards, "it's higher doses of more drugs quicker and that might give an advantage."

Hodgkin's disease patients in the United States typically receive the regimen ABVD -- COPP-ABVD has fallen from favor after U.S. studies didn't support its use, Armitage says. So before BEACOPP becomes the standard of care here, it will have to be pitted against ABVD. "If it is better than ABVD, then I have no doubt that it will get adopted," he says.

A report on the findings appears in the June 12 edition of The New England Journal of Medicine.

Hodgkin's disease, also known as Hodgkin lymphoma, is a blood-related cancer that affects some 7,000 people a year in the United States, according to the Leukemia & Lymphoma Society. Treatment advances since the 1960s have greatly improved the odds for patients with the disease, and five-year survival rates hover around 90 percent. Many patients can realistically hope to be cured of the disease.

In the latest study, Dr. Volker Diehl, of the University of Cologne, led a research team that followed 1,201 men, women and teenagers with advanced Hodgkin's disease. At the start of the study in 1993, patients were randomly given COPP-ABVD, BEACOPP or high-dose BEACOPP.

By 1996, it was clear that COPP-ABVD was inferior to either of the other two treatments, so no additional patients were assigned to that group.

Alan Kinniburgh, vice president for research at the Leukemia & Lymphoma Society, in White Plains, N.Y., says the study results build a strong case for using BEACOPP in patients with advanced Hodgkin's disease.

But while the study is good news for most people with the cancer, some forms of the disease are more lethal than others. And in these patients, the survival rates can be quite low. "There are some aggressive forms, and we need to find new therapies," he says.

Kinniburgh's foundation is pushing for scientists to develop vaccine-based approaches to the disease.

In about 30 percent of people with Hodgkin's disease, the cancerous cells are infected with Epstein-Barr virus, the microbe that causes mononucleosis. "It probably drives the growth of those malignant cells," Kinniburgh says.

Other viruses may influence the course of the cancer, too, he says, so bolstering the body's defenses against these pathogens may help fight Hodgkin's disease.

In an unrelated study also appearing in the same journal, European researchers say radiation after chemotherapy doesn't help Hodgkin's patients live longer or reduce their odds of the disease's return. Radiation of areas affected by cancer -- so-called "involved fields" -- does appear to improve results in patients in partial remission. Yet it does so with the price of an increased risk of other cancers, the study says.

"Particularly in young patients, radiation would be something to be avoided, especially if the involved field is a lung or other major organ," Kinniburgh says.

More information

To learn more about Hodgkin's disease, visit the National Institutes of Health or the Leukemia & Lymphoma Society.

SOURCES: Alan Kinniburgh, Ph.D., vice president for research, Leukemia & Lymphoma Society, White Plains, N.Y.; James O. Armitage, M.D., dean, College of Medicine, University of Nebraska, Omaha; June 12, 2003, New England Journal of Medicine
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