Evaluation of the efficacy of the VEEP regimen in adult Hodgkin's disease with assessment of gonadal and cardiac toxicity.
OBJECTIVE
The aim of this phase II study was to investigate the potential of the vincristine, epirubicin, etoposide, and prednisolone (VEEP) regimen to reduce the risks of long-term sequelae of chemotherapy such as sterility, cardiopulmonary damage, and second malignancies, while maintaining efficacy in terms of response and survival.


METHODS
Eighty-five adult patients with newly diagnosed and previously untreated stage II to IV Hodgkin's disease (HD) were entered and monitored for a minimum of 1 year. Patients were treated to maximum response plus two further courses, and if they had not attained a complete response (CR) or CR-unconfirmed/uncertain [CR(u)] were changed to second-line chemotherapy. Adjuvant radiotherapy was administered to patients with bulky disease and those with postchemotherapy residual masses. Measurements of left ventricular ejection fraction (LVEF), gonadotropins in females, and sperm count in males were taken both before and after treatment with VEEP.


RESULTS
The maximum rates of response were as follows: CR, 32%; CR(u), 47%; and PR, 21% [CR + CR(u), 79%]. The median follow-up duration is 45 months, with a 5-year overall survival (OS) rate of 89% and failure-free survival (FFS) rate of 62%. Patients in CR at the end of chemotherapy had a higher FFS at 5 years compared with patients in CR(u) (88% v 56%). Acute toxicity was mild, with no pulmonary toxicity or treatment-related deaths. The median LVEF was 62% before VEEP and 57% after VEEP. Gonadal function tests following treatment were normal in 92% of males and 100% of females. No second malignancies have been observed.


CONCLUSIONS
VEEP is an active combination with tolerable acute toxicity that preserves fertility and cardiopulmonary function. The efficacy of VEEP is comparable to that of established regimens, but a definitive evaluation of its potential to reduce second malignancies will require a longer follow-up duration.
Hill
M
M
Cancer Research Campaign Section of Medicine, Royal Marsden Hospital, Sutton, United Kingdom.
Milan
S
S
Cunningham
D
D
Mansi
J
J
Smith
I
I
Catovsky
D
D
Gore
M
M
Zulian
G
G
Selby
P
P
Horwich
A
A
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use* / Q000633:toxicity*; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity; D005260:Female; D005298:Fertility / Q000187:drug effects; D005500:Follow-Up Studies; D006062:Gonadotropins / Q000097:blood; D006066:Gonads / Q000187:drug effects*; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity; D013076:Sperm Count; D013318:Stroke Volume / Q000187:drug effects*; D013997:Time Factors; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity
D006062:Gonadotropins; D015251:Epirubicin; D014750:Vincristine; D005047:Etoposide; D011239:Prednisolone