Devita, Hellman, and Rosenberg's Cancer

LWBK1006-30 LWW-Govindan-Review December 12, 2011 19:35

426 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 30.48. The GHSG recently conducted a series of clinical trials to look at the

role of dose intensification in advanced HL. The BEACOPP regimen

(bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, pro-

carbazine, and prednisone) was used as a standard combination for dose

escalation. The GHSG designed a three-arm study comparing COPP/

ABVD, standard BEACOPP, and escalated BEACOPP in patients with

advanced HL. Approximately two-thirds of the patients also received

consolidation RT. In 1996, at an interim analysis, the COPP/ABVD arm

was closed to accrual because it was inferior to the BEACOPP arm. All

of the following statements about the GHSG trial are true, EXCEPT:

A. At a median of 5 years, the freedom from treatment failure rate was

69% for COPP/ABVD, 76% for standard BEACOPP, and 87% for

the escalated BEACOPP.

B. There were nine cases of AML/MDS in the escalated BEACOPP arm,

whereas there were two cases in the standard BEACOPP arm; also, the

total rate of second neoplasms was highest in the escalated BEACOPP

arm.

C. Escalated BEACOPP was associated with greater hematologic toxic-

ity, requiring more red cell and platelet transfusions, but there were no

differences in hematologic toxicity between the standard BEACOPP

arm and the COPP/ABVD arm.

D. Rates of early progression were significantly lower with the escalated

BEACOPP compared with standard BEACOPP and COPP/ABVD.

Question 30.49. Several trials have looked at the use of less-toxic chemotherapy combined

with RT. These combinations would allow a reduction in the amount and

toxicity of chemotherapy and the use of smaller radiation volumes. All of

the following statements are true, EXCEPT:

A. A less-toxic regimen, vinblastine, bleomycin, and methotrexate

(VBM) was developed at Stanford. A trial treating patients with PS IA

to IIIA compared subtotal nodal/total nodal irradiation with involved

field irradiation followed by VBM. There was no significant differ-

ence in OS.

B. The British National Lymphoma Investigation (BNLI) trial found that

the combination of VBM with involved field irradiation produced

unacceptable pulmonary and hematologic toxicity.

C. In a later Stanford trial, patients with CS IA-IIIA HL received subtotal

nodal and splenic irradiation or two cycles of VBM, followed by

regional mantle irradiation and then four more cycles of VBM with

dose-reduced bleomycin. There was no difference in PFS or OS.

D. The GHSG HD7 (1994 to 1998) trial randomized 643 CS IA-IIB

patients to either subtotal nodal and splenic irradiation alone or to

two courses of ABVD and the same RT. No difference was seen in

the freedom from treatment failure between the two groups.