Several interesting presentations about potential advances in the treatment of AIDS-related non-Hodgkin's lymphoma were made. This disease has been plagued with a high rate of incomplete responses as well as a high rate of relapse with conventional therapy. This is an especially significant problem in patients with low T-cell counts that are quite sick at the time of initial presentation. When this disease relapses, it is notably difficult to treat and most patients do not live very long.

Alexandra Levine at the University of Southern California spoke about her experience with 2 regimens previously used in HIV-negative patients: dexamethasone, ara-c (cytosine arabinoside, also called cytarabine), and cisplatin (DHAP); and etoposide, methylprednisolone, high-dose cytarabine and cisplatin (ESHAP). She reviewed her retrospective experience in the use of these drugs in 26 consecutive patients with either relapsed lymphoma or lymphoma that was initially unresponsive to therapy. She found that ESHAP was quite likely to work, with a complete disappearance of tumor in 31% of patients and a greater than 50% reduction tumor in another 31% of patients. Although a large percentage of these patients responded, they lived an median of 6-1/2 months from the start of treatment. This suggests that although the response rate to ESHAP is better than many other published regimens, responses are still very short-lived and only a small proportion of patients can be cured with this sort of salvage therapy.

Chemotherapy administered by continuous infusion was also studied by two groups. Sparano, at the Montefiori Cancer Center in New York, discussed his cyclophosphamide, doxorubicin and etoposide (CDE) regimen, where the three drugs are given as a 96-hour continuous intravenous infusion rather than over shorter periods of time as is usual for these drugs. This regimen was well tolerated and in comparison with a previous study using the standard regimen for this disease -- methotrexate with leucovorin rescue, bleomycin, adriamycin, cyclophosphamide, vincristine (trade name Oncovin), and dexamethasone (m-BACOD) -- there was an improved patient survival.

Even more impressive was data from the National Cancer Institute presented by Richard Little, of etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (hydroxydaunorubicin, trade name Adriamycin) (EPOCH). This treatment had been studied at the NCI for a number of years in HIV-positive and HIV-negative patients with a good deal of success. It is also an infusional regimen, although only 3 of the 5 drugs are given by continuous infusion. Of 30 patients on the study, 23 achieved a complete response to treatment. This represents a 77% response rate, which is the highest ever reported in this situation. Even more impressive is that not one of these 23 patients have had a relapse of their lymphoma to date. At the time of this presentation, 81% of patients have had no relapse and 74% are still alive after an average follow-up of thirty months. Although other than having lymphoma, patients at the NCI are primarily selected for their good health and functional ability (which can improve response and cure rates), this data is strikingly impressive in comparison to any other similar trial from the past. More work will need to be done with this regimen to see if it holds up in a larger trial, but this seems to be a very promising therapy for lymphoma.

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