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| |  ASTRO: ABVD Effective for Hodgkin’s, but Pulmonary Toxicity May be Worse for Elderly By Emma Hitt Special to DG News NEW ORLEANS, LA -- October 10, 2002 -- Research findings suggest that newer adriamycin-based regimens may be preferable to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in older patients with Hodgkin’s disease. Treatment with ABVD is effective but is associated with pulmonary toxicity, especially in older patients, according to Dr. Andrea K. Ng, from the department of radiation oncology at Brigham and Women’s Hospital, in Boston, Massachusetts, United States. She presented the research here October 9 at the 44th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO). A total of 175 patients with Hodgkin’s disease received ABVD as part of their initial treatment between 1987 and 1998. Patient age ranged from 9 to 71 years; 9 were older than 50 years, and 7 were older than 60. A total of 139 patients with clinical stage (CS) I-II disease received ABVD, 125 with radiation therapy and 14 without. Thirty-six patients with CS III-IV disease received ABVD, 21 with radiation therapy and 15 without. Median follow-up time was 5 years and 4 months. A total of 132 patients (95 percent) with CS I-II disease and 31 patients (86 percent) with CS III-IV disease achieved a complete response to initial treatment. For CS I-II patients achieving a complete response, the 5-year overall survival was 95 percent, freedom from treatment failure (FFTF) was 95 percent, and progression-free survival (PFS) was 92 percent. For CS III-IV patients, these values were 90 percent, 76 percent, and 70 percent, respectively. Dr. Ng and colleagues also evaluated the entire cohort for pulmonary toxicity. Twenty-five patients (14 percent) developed bleomycin toxicity requiring discontinuation of the drug. Twelve patients (7 percent) developed pneumonitis requiring either steroids or antibiotics at a median of 3 months post-treatment. None of the factors analysed -- including age, disease bulk, number of cycles of chemotherapy, addition of radiation therapy, radiation field size and radiation dose -- significantly predicted for pulmonary toxicity. However, of the 20 patients who died, five died of pulmonary causes. Three were aged over 60 years at the time of treatment; the fourth was 15 years old at diagnosis and died of lung complications after an autologous bone marrow transplant. The fifth was 26 years old and received whole lung radiation therapy after ABVD. "Our results confirmed the effectiveness of ABVD in the treatment of Hodgkin’s disease," the researchers conclude. "The poor prognosis in patients who did not achieve a complete response suggests the need for more aggressive salvage therapy in these patients," they add. "We are a bit surprised by the high number of patients who died of pulmonary toxicity," Dr. Ng said. "And since three of the five patients were over 60, it suggests that older patients are at higher risk for fatal lung toxicity." Dr. Ng also presented data at the meeting on post-chemotherapy gallium scans in these patients. A total of 16 patients with a positive gallium scan were treated with conventional dosing and "11 of the 16 patients did well," she said. "This suggests that some patients with a positive gallium scan may not need to receive a transplant, but more work is needed to identify these patients," she concluded.
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