Bleomycin, vinblastine and dacarbazine combined with nonpegylated liposomal doxorubicin (MBVD) in elderly (≥70 years) or cardiopathic patients with Hodgkin lymphoma: a phase-II study from Fondazione Italiana Linfomi (FIL)

Abstract

This phase-II study assessed activity and toxicity of substituting conventional doxorubicin with nonpegylated liposomal doxorubicin in the conventional ABVD regimen for the treatment of elderly or cardiopathic patients with HL. Stage I-IIA and IIB-IV patients were treated with three courses of MBVD plus radiotherapy, or six courses of MBVD, respectively, plus radiotherapy limited to bulky or residual disease areas. The primary endpoints were CR rate and the rate of cardiac events. Forty-seven patients were enrolled. Median age was 75 years, 13 had stage I-II disease. Overall, CR was achieved by 36 patients (77%, 95% CI: 62-88), 100% and 68% in stage I-II and III-IV, respectively. With a median follow-up of 40 months (IQR: 36-45). Three-year overall survival (OS) and progression-free survival (PFS) were 70% and 43%, respectively. Cardiac events grades 3-5 were reported in two patients. In conclusion, MBVD's activity and safety profile was comparable to historical ABVD data.

Liposomal doxorubicin supercharge‐containing front‐line treatment in patients with advanced‐stage diffuse large B‐cell lymphoma or classical Hodgkin lymphoma: Preliminary results of a single‐centre phase II study

“…[10][11][12] The schemes resulted as a safe option, with activity profile comparable to historical R-CHOP and ABVD data. [10][11][12] Liposomal doxorubicin at increased dose may have some pharmacokinetic and pharmacodynamic advantages 13 : it rapidly accumulates at high levels within tumour-associated macrophages of the lymphadenopathy microenvironment, and within the reticuloendothelial system (RES) of the spleen, liver, lung, and bone. [14][15][16][17][18][19][20] In real-life, these effects might be perceived as a great benefit in those patients with DLBCL or c-HL with a high tumour burden, regardless of age or comorbidities.…”

“…The dosages of Myocet™ in the R-COMP-DI and MBVD-DI schemes were a personal extrapolation from published in vitro and in vivo data, as they were not previously established. [10][11][12][13][16][17][18] However, the Myocet™ administrations were well within the ceiling dose of 785 mg/m 2 (the median lifetime dose reported for NPLD at the onset of cardiotoxicity). 9 Patients with DLBCL were scheduled to receive the first three cycles of therapy with R-COMP-DI which consisted of 1-day outpatient intravenous (i.v.)…”

Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience

“…The ABVD regimen (adriamycin, bleomycin, vinblastine, dacarbazine) is considered gold standard for young cHL patients, but has significant toxicities in the elderly that limit its use above the age of 60–65 years. The use of a less intensive approach translates into a reduction of the expected toxicity, but unfortunately, it is counterbalanced by a non‐optimal efficacy 6–9 . For that reason, the attention of many authors has focused on trying to ameliorate the ABVD scheme, by substituting or removing single drugs and/or by combining an ABVD backbone with the anti‐CD30 monoclonal antibody brentuximab vedotin 10,11 …”

“…The use of a less intensive approach translates into a reduction of the expected toxicity, but unfortunately, it is counterbalanced by a non‐optimal efficacy. 6 , 7 , 8 , 9 For that reason, the attention of many authors has focused on trying to ameliorate the ABVD scheme, by substituting or removing single drugs and/or by combining an ABVD backbone with the anti‐CD30 monoclonal antibody brentuximab vedotin. 10 , 11 …”

Comorbidity assessment to determine prognosis in older adult patients with classical Hodgkin lymphoma

“…In contrast, treatment of older adult patients with HL still remains a challenge. Outcome is worse even when ABVD‐derived regimens are given . Currently, the important drug toxicities associated with the standard chemotherapy regimens used for HL do not allow to formulate recommendations for older adult HL.…”