A randomized EPOCH vs. CHOP front-line therapy for aggressive non-Hodgkin's lymphoma patients: Long-term results

• Published in: Annals of oncology Vol. 10; no. 12; pp. 1489 - 1492
• Main Authors: Khaled, H. M., Zekri, Z. K., Mokhtar, N., Ali, N. M., Darwish, T., Elattar, I., Gaafar, R., Moawad, M. S.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-12-1999
• Subjects: Adult; Aged; aggressive NHL; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; CHOP; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; EPOCH; Etoposide - administration & dosage; Female; Humans; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Non-Hodgkin - drug therapy; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; phase III randomised trial; Prednisone - administration & dosage; Survival Analysis; Vincristine - administration & dosage; Antineoplastic agent; Human; Drug combination; Etoposide; Malignant hemopathy; Non Hodgkin lymphoma; Doxorubicin; Vincristine; Podophyllotoxine derivatives; Alkaloid; Chemotherapy; Cyclophosphamide; Oxazaphosphinane derivatives; Treatment; Lymphoproliferative syndrome; Nitrogen mustard; Anthracyclins; Therapeutic protocol; Comparative study
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1023/A:1008395014398

Background: The value of continuous-infusion chemotherapy (EPOCH) vs. the standard CHOP combination was evaluated in 78 patients with previously untreated aggressive non-Hodgkin's lymphoma in a randomized phase III clinical trial. Patients and methods: The EPOCH regimen given to 38 patients consisted of the drugs etoposide (50 mg/m2), vincristine (0.4 mg/m2), and doxorubicin (10 mg/m2), all given in a continuous infusion on days 1–4. Cyclophosphamide (750 mg/m2) was administered on day 6 as i.v. bolus, while prednisone was given orally 60 mg/m2 on days 1–6. Courses were repeated every three weeks. CHOP was given to 40 patients as routinely prescribed. Results: Forty-eight patients were males and thirty were females. Their ages ranged from 19–75 years (median 45 years). Forty-three (55%) had grade 2 and thirty-five (45%) had grade 3 pathologic subtype. Nine patients (12%) presented with stage I, fourteen (18%) with stage II, forty (51%) with stage III, and fifteen (19%) with stage IV disease. The different clinico-pathologic characteristics, including international index categories, were comparable in the two groups. The number of courses given ranged between 3 and 9 (median 6) for both the EPOCH and CHOP regimens. Complete remission (CR) was achieved in 19 (50%), and 27 (67%) of the 38 and 40 patients for both the EPOCH and CHOP combinations, respectively. After a median observation time of 27 months, the four-year overall and failure-free survival rates were 42% and 30% for the EPOCH and 71% and 54% for the CHOP regimen (P = 0.006 and 0.1 for the overall and FFS rates, respectively). Toxicities were comparable and were mostly of grades 1 and 2, except for hair loss, hematologic toxicities, and infectious episodes which were more common in the EPOCH group. In the EPOCH group, overall survival rates were 55% vs. 22% (P < 0.04) at four years for the low-risk (2 prognostic factors) and high-risk (> 2 factors) groups, respectively. Conclusions: Thus, it may be concluded that continuous-infusion (EPOCH) chemotherapy did not improve treatment outcome over that of the CHOP regimen for aggressive non-Hodgkin's lymphoma patients.