TY - JOUR
T1 - Prospectively randomized clinical trial of three intensive chemotherapy regimens for the treatment of advanced unfavorable histology non-Hodgkin's lymphoma
AU - O'Connell, M. J.
AU - Harrington, D. P.
AU - Earle, J. D.
AU - Johnson, G. J.
AU - Glick, J. H.
AU - Carbone, P. P.
AU - Creech, R. H.
AU - Neiman, R. S.
AU - Mann, R. B.
AU - Silverstein, M. N.
PY - 1987
Y1 - 1987
N2 - Three hundred thirty-two eligible patients with advanced (Ann Harbor stage III or IV) non-Hodgkin's lymphoma of aggressive histologic subtype (Rappaport classification diffuse histiocytic [DH], diffuse poorly differentiated lymphocytic [DPDL], diffuse mixed [DM], or diffuse undifferentiated [DU] were randomly assigned to receive induction chemotherapy with one of three intensive regimens in a clinical trial conducted by Eastern Cooperative Oncology Group (ECOG) between 1978 and 1983. Chemotherapy regimens consisted of cyclophosphamide, vincristine, prednisone, and doxorubicin (Adriamycin; Adria Laboratories, Columbus, OH) (COPA) administered in 3-week cycles; cyclophosphamide plus doxorubicin plus prednisone beginning day 1, with vincristine plus bleomycin day 15 of each 3-week cycle (COPA + Bleo); or cyclophosphamide plus doxorubicin plus procarbazine beginning day 1, and bleomycin plus vincristine plus prednisone beginning day 15 of each 4-week cycle (CAP-BOP). The median patient follow-up from study entry for patients still alive is 5 years. The three regimens were not significantly different with respect to complete response (CR) rates (43% to 46%), time to progression of malignant disease (median, 1.0 to 1.7 years), or survival (5-year survival, 34% to 46%) although duration of complete remission appeared to be shorter in patients receiving COPA (P=.03). COPA + Bleo and CAP-BOP were significantly more toxic than the COPA regimen. This study did not demonstrate any substantial therapeutic advantage associated with the addition of a fifth or sixth chemotherapy drug, or with treatment administered on a more frequent administration schedule, compared with the COPA regimen in this population of patients with advanced diffuse non-Hodgkin's lymphoma. The relatively small proportion of long-term disease-free survivors treated with COPA underscored the need for prospective clinical trials of new and more effective treatments for patients with these potentially curable tumors.
AB - Three hundred thirty-two eligible patients with advanced (Ann Harbor stage III or IV) non-Hodgkin's lymphoma of aggressive histologic subtype (Rappaport classification diffuse histiocytic [DH], diffuse poorly differentiated lymphocytic [DPDL], diffuse mixed [DM], or diffuse undifferentiated [DU] were randomly assigned to receive induction chemotherapy with one of three intensive regimens in a clinical trial conducted by Eastern Cooperative Oncology Group (ECOG) between 1978 and 1983. Chemotherapy regimens consisted of cyclophosphamide, vincristine, prednisone, and doxorubicin (Adriamycin; Adria Laboratories, Columbus, OH) (COPA) administered in 3-week cycles; cyclophosphamide plus doxorubicin plus prednisone beginning day 1, with vincristine plus bleomycin day 15 of each 3-week cycle (COPA + Bleo); or cyclophosphamide plus doxorubicin plus procarbazine beginning day 1, and bleomycin plus vincristine plus prednisone beginning day 15 of each 4-week cycle (CAP-BOP). The median patient follow-up from study entry for patients still alive is 5 years. The three regimens were not significantly different with respect to complete response (CR) rates (43% to 46%), time to progression of malignant disease (median, 1.0 to 1.7 years), or survival (5-year survival, 34% to 46%) although duration of complete remission appeared to be shorter in patients receiving COPA (P=.03). COPA + Bleo and CAP-BOP were significantly more toxic than the COPA regimen. This study did not demonstrate any substantial therapeutic advantage associated with the addition of a fifth or sixth chemotherapy drug, or with treatment administered on a more frequent administration schedule, compared with the COPA regimen in this population of patients with advanced diffuse non-Hodgkin's lymphoma. The relatively small proportion of long-term disease-free survivors treated with COPA underscored the need for prospective clinical trials of new and more effective treatments for patients with these potentially curable tumors.
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U2 - 10.1200/JCO.1987.5.9.1329
DO - 10.1200/JCO.1987.5.9.1329
M3 - Article
C2 - 2442322
AN - SCOPUS:0023549398
SN - 0732-183X
VL - 5
SP - 1329
EP - 1339
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 9
ER -