Sequential versus alternating chemotherapy for high grade non‐hodgkin's lymphomas: A randomized multicentre trial

Abstract

In a multicentre phase III trial 146 previously untreated patients with high grade non-Hodgkin's lymphomas stage II-IV were randomized to receive either four cycles of CHOEP (cyclophosphamide 750 mg/m2 iv d 1, doxorubicin 50 mg/m2 iv d 1, vincristine 2 mg iv d 1, etoposide 100 mg/m2 iv d 3-5, prednisolone 100 mg po d 1-5) (treatment arm A), or four cycles of chemotherapy with hCHOP (cyclophosphamide 1200 mg/m2 iv d 1, doxorubicin 40 mg/m2 iv d 1 + 2, vincristine 2 mg iv d 1, prednisolone 100 mg po d 1-5) alternating with IVEP (ifosfamide 1500 mg/m2 iv d 1-5, vindesine 3 mg/m2 iv d 1, etoposide 120 mg/m2 iv d 3-5, prednisolone 100 mg po d 1-5) (treatment arm B). After four cycles of chemotherapy an involved field irradiation with a total dose of 35 Gy was given to all patients in complete or partial remission without persisting extranodal disease. A complete response (CR) was seen in 124/146 patients (86 per cent) with 87 per cent CR in arm A versus 83 per cent CR in arm B. During a median follow-up of 17 months (range 2-40) 30 patients relapsed (16 patients arm A, 14 patients arm B). The overall survival at 40 months is projected to be 71 per cent versus 70 per cent for arm A and B, respectively. Disease-free survival is projected to be 68 per cent in arm A and 59 per cent in arm B at 40 months. So far, the differences in CR, survival and disease-free survival are not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

An overview on anti-tubulin agents for the treatment of lymphoma patients

“…Vindesine is a desacetyl derivative of vinblastine, registered in Europe in 1980 and available only for investigational purposes in the United States. Main indications of vindesine are in multi-drug chemotherapy protocols for lymphomas (Buzzoni, et al, 1993;Casasnovas, et al, 2017;Coiffier, et al, 1990;Coiffier, et al, 1987;Fitoussi, et al, 2011;Herbrecht, et al, 1991;Ishida, et al, 2015;Ketterer, et al, 2013;Koppler, et al, 1991;Lennard, et al, 1989;Merli, et al, 2016;Pfreundschuh, et al, 1987;Recher, et al, 2011;Riccardi, et al, 1993;Toyoda, et al, 2019). Among these, the dose intense regimen R-ACVBP (rituximab, vindesine, doxorubicin, cyclophosphamide, bleomycin and prednisone) is superior to standard R-CHOP in terms of clinical activity, but with a worse toxicity profile (Recher, et al, 2011).…”