Three cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or epirubicin, bleomycin, vinblastine, and methotrexate (EBVM) plus extended field radiation therapy in early and intermediate Hodgkin disease: 10-year results of a randomized trial.
From 1990 to 1996, a total of 386 adult patients with early/intermediate Hodgkin disease (HD) were randomly assigned to receive 3 cycles of adriamycin, bleomycin, vinblastine, dacarbazine (an alkylating agent), and methylprednisolone (ABVDm, arm A) or epirubicin, bleomycin, vinblastine, methotrexate, and methylprednisolone (EBVMm, arm E), a combination without alkylating agent. Responding patients received extended field radiation therapy (RT). Postchemotherapy complete remission and 10-year freedom from progression rates were higher in arm A (79.5% and 91.4%) than in arm E (70.4%, P =.04, and 80%, P <.002). HD mortality (HDM), treatment-related mortality (TRM), and overall survival (OS) were similar in both arms (A, 2.1%, 7.5%, and 90.4%; B, 3.9%, 5.5%, and 90.3%). However TRM and OS rates were lower in patients aged 40 years or older (P <.005), reflecting the increasing incidence of background fatal events with increasing age. Finally, event-free survival (EFS) was higher in arm A (84.6%) than in arm E (74.9%, P <.02). In patients aged younger than 40 years in arm A (74%), 10-year EFS and OS rates were 88.9% and 95.4% with HDM and TRM rates as low as 0.7% and 3%. Three courses of ABVDm plus RT are the best available option for treating early or intermediate HD.
le Maignan
Christine
C
Cancérologie médicale, Hôpital Européen Georges Pompidou, Paris, France.
Desablens
Bernard
B
Delwail
Vincent
V
Dib
Mahmoud
M
Berthou
Christian
C
Vigier
Magda
M
Ghandour
Christiane
C
Atmani
Said
S
Casassus
Philippe
P
Maisonneuve
Herve
H
Le Mevel
Annick
A
Traulle
Catherine
C
Bernard
Marc
M
Briere
Josette
J
Colonna
Pierre
P
Andrieu
Jean-Marie
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000009:adverse effects / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005602:France / Q000453:epidemiology; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use
D001761:Bleomycin; D015251:Epirubicin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D008727:Methotrexate