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choices other than CHOP
Mar 2, 2001

A recent article in Poz (Jn. 2001) seemed to suggest that CHOP was somewhat of an old line treatment for NHLymphoma. It suggested complete remission in 94 percent of people using EPOCH and 50 in people using m-BACOD as opposed to only 1/3 on CHOP. Should I be considering something other than CHOP? Can treatments be switched mid-stream? My doctor is planning on adding Rituxan later on in the treamtn, you haven't mentioned this recently, is this a good choice? Thanks, WayTooManyChoices

Response from Dr. Dezube

You raise an interesting and important question! The bottom line is that CHOP is still the standard treatment for NHL lymphoma. I do NOT agree with the numbers you quote. Typically, what happens is that investigators try new regimens in highly selected patients and often come up with numbers that look quite good. HOWEVER, when new regimens are tested against standard regimens in a randomized fashion (this assures that the patient populations are similar), the new regimen may indeed not be better than the "tried and true" regimen. In fact, this was the case with an m-BACOD vs. CHOP trial. In that randomized trial, CHOP had a better benefit to risk ratio than m-BACOD. (This trial was conducted in HIV-negative lymphoma; no such trial has been done in HIV'ers). More important than the specific regimen is that your viral load be under control and so on. In terms of EPOCH, although I do agree that the data look promising, it is a much more cumbersome regimen. I think it is premature at this time to embrace it as standard of care.

I would NOT recommend switching mid-stream, as there is no evidence to suggest that it helps.

In terms of Rituxan (antibody against lymphoma), its use in this setting is still investigational. I do admit that some health care providers are offering it to their patients. This is based on a recent French study, which showed that in HIV-negative patients, patients who received Rituxan fared better. The NIH/National Cancer Institute is currently testing the use of Rituxan in HIV'ers. For my patients who do not enroll in this trial, I personally treat them with standard CHOP. If they are willing to enroll in this NIH trial, then they are randomized to CHOP with or without Rituxan. Until the results of this study are in, I believe that use of Rituxan in this setting is a bit premature. However, I can not make a strong argument against the suggestion of your physician. Good Luck. I have many patients who are cured of this disease and are alive a decade after their chemotherapy. Hopefully, you'll do well no matter what path you take.


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