Standard treatment for Hodgkin's lymphoma is combination chemotherapy with or without additional radiation.1

Radiation Therapy

In adult Hodgkin's lymphoma, the appropriate dose of radiation is 2,500 cGy to 3,000 cGy to clinically uninvolved sites, and 3,500 cGy to 4,400 cGy to regions of initial nodal involvement.2-5 These recommendations are often modified in pediatric or advanced-staged adult patients who also receive chemotherapy. Treatment is usually delivered to the neck, chest, and axilla (mantle field) and then to an abdominal field to treat para-aortic nodes and the spleen (splenic pedicle). With careful treatment technique, the risk of cardiac and pulmonary complications is small.6,7

Hodgkin's Lymphoma Drug Combinations1

  • ABVD: doxorubicin + bleomycin + vinblastine + dacarbazine
  • BEACOPP: bleomycin + etoposide + doxorubicin + cyclophosphamide + vincristine + procarbazine + prednisone
  • COPP/ABVD: cyclophosphamide + vincristine + procarbazine + prednisone/doxorubicin + bleomycin + vinblastine + dacarbazine
  • MOPP: mechlorethamine + vincristine + procarbazine + prednisone
  • MOPP/ABV hybrid: mechlorethamine + vincristine + procarbazine + prednisone/doxorubicin + bleomycin + vinblastine
  • Stanford V: doxorubicin + vinblastine + mechlorethamine + etoposide + vincristine + bleomycin + prednisone

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Clinical Data in Advanced Hodgkin's Lymphoma

Clinical trial results in patients with advanced Hodgkin's lymphoma1:

ABVD and MOPP

The ABVD regimen demonstrated superior failure-free survival compared with MOPP in 2 trials and superior overall survival in one trial.8-10

  • In the first, the 5-year rate of failure-free survival was 50% for MOPP, 61% for ABVD, and 65% for MOPP alternating with ABVD (P=0.02 for the comparison of MOPP to other regimens).8 At a median follow-up of 14.1 years, ABVD and MOPP-ABVD continued to demonstrate significant benefits in failure-free survival (see Kaplan-Meyer curve below)9

Long-term survival benefit of ABVD and MOPP-ABVD vs MOPP

  • In a trial with a 7-year follow-up, MOPP demonstrated an overall survival rate of 68% compared with a survival rate of 77% with ABVD (P<0.03)10

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ABVD and MOPP/ABV

The Intergroup trial comparing ABVD with the MOPP/ABV hybrid showed equivalent efficacy in failure-free survival and overall survival, but increased toxic effects in the hybrid arm, especially from second malignancies.11

  • The 5-year failure-free survival was 63% for ABVD and 66% for MOPP/ABV
  • The 5-year overall survival was 82% for ABVD and 81% for MOPP/ABV

Equivalent survival benefit with ABVD and MOPP/ABV

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BEACOPP and COPP/ABVD

The German Hodgkin's Lymphoma Study Group randomized patients with advanced-stage disease to COPP/ABVD, BEACOPP, or to increased-dose BEACOPP

  • 5-year overall survival was 83% for COPP/ABVD, 88% for BEACOPP, and 91% for increased-dose BEACOPP12

Long-term survival benefit with increased-dose BEACOPP vs BEACOPP and COPP-ABVD12

Click here for more information about the BEACOPP regimen in adults.

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Treatment of Children and Adolescents

Increased-dose BEACOPP has also demonstrated improved early tumor control in children and adolescents. In a recent trial with 99 previously untreated children (Children's Oncology pilot study), early response rates were 45% and 72%, after 2 and 4 cycles of induction, respectively.13

Click here for more information about the BEACOPP regimen in children and adolescents.

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Stanford V

Stanford V is an alternative drug combination currently under clinical evaluation.1 In this treatment regimen, 7 different chemotherapy drugs are administered over a shorter period of time but more frequently than with standard chemotherapy regimens. To evaluate the overall benefit, a large intergroup trial is currently underway.14

Information on Hodgkin's lymphoma is reproduced courtesy of the National Cancer Institute: www.nci.nih.gov.

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References:

  1. National Cancer Institute Treatment option overview. In: Adult Hodgkin's Lymphoma (PDQ): Treatment. Available at http://www.nci.nih.gov/ cancertopics/pdq/treatment/adulthodgkins/healthprofessional/page4. Accessed June 17, 2005.
  2. Sears JD, Greven KM, Ferree CR, et al. Definitive irradiation in the treatment of Hodgkin's disease. Analysis of outcome, prognostic factors, and long-term complications. Cancer. 1997;79:145-151.
  3. Ng AK, Mauch PM. Radiation therapy in Hodgkin's lymphoma. Semin Hematol. 1999;36:290-302.
  4. Dühmke E, Franklin J, Pfreundschuh M, et al.: Low-dose radiation is sufficient for the noninvolved extended-field treatment in favorable early-stage Hodgkin's disease: long-term results of a randomized trial of radiotherapy alone. J Clin Oncol. 2001;19:2905-2914.
  5. Mendenhall NP, Rodrigue LL, Moore-Higgs GJ, et al. The optimal dose of radiation in Hodgkin's disease: an analysis of clinical and treatment factors affecting in-field disease control. Int J Radiat Oncol Biol Phys. 1999;44:551-561.
  6. Tarbell NJ, Thompson L, Mauch P. Thoracic irradiation in Hodgkin's disease: disease control and long-term complications. Int J Radiat Oncol Biol Phys. 1990;18:275-1281.
  7. Marcus KC, Svensson G, Rhodes LP, et al. Mantle irradiation in the upright position: a technique to reduce the volume of lung irradiated in patients with bulky mediastinal Hodgkin's disease. Int J Radiat Oncol Biol Phys. 1992;23:443-437.
  8. Canellos GP, Anderson JR, Propert KJ, et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 1992;327:1478-1484.
  9. Canellos GP, Niedzwiecki D. Long-term follow-up of Hodgkin's disease trial. N Engl J Med. 2002;346:1417-1418.
  10. Bonfante V, Santoro A, Viviani S, et al. ABVD in the treatment of Hodgkin's disease. Semin Oncol. 1992;19(2 suppl 5):38-44; discussion 44-45.
  11. Duggan DB, Petroni GR, Johnson JL, et al. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin's disease: report of an intergroup trial. J Clin Oncol. 2003;21:607-614.
  12. Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med. 2003;348:2386-2395.
  13. Kelly KM, Hutchinson RJ, Sposto R, et al. Feasibility of upfront dose-intensive chemotherapy in children with advanced-stage Hodgkin's lymphoma: preliminary results from the Children's Cancer Group Study CCG-59704. Ann Oncol. 2002;13(suppl 1):107-111.
  14. Horning SJ, Hoppe RT, Breslin S, Bartlett NL, Brown BW, Rosenberg SA. Stanford V and radiotherapy for locally extensive and advanced Hodgkin's disease: mature results of a prospective clinical trial. J Clin Oncol. 2002;20:607-609.

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Important Safety Information

WARNING
It is recommended that MATULANE be given only by or under the supervision of a physician experienced in the use of potent antineoplastic drugs. Adequate clinical and laboratory facilities should be available to patients for proper monitoring of treatment.

Matulane is contraindicated in patients with known hypersensitivity to the drug or inadequate marrow reserve as demonstrated by bone marrow aspiration. Due consideration of this possible state should be given to each patient who has leukopenia, thrombocytopenia, or anemia.

Matulane in combination therapy is a potent chemotherapeutic agent. Before prescribing Matulane, the sections in the Prescribing Information concerning usage in pregnancy, occurrence of secondary cancers, monitoring required in liver and kidney disease, hematologic effects, CNS effects, and potentiation associated with alcohol and MAO inhibitors should be carefully evaluated.

Please see full Prescribing Information for Matulane indications and usage, contraindications, and warnings including boxed WARNINGS, precautions, and adverse reactions.