A PHASE-III COMPARISON OF CHOP VS M-BACOD VS PROMACE-CYTABOM VS MACOP-B IN PATIENTS WITH INTERMEDIATE-GRADE OR HIGH-GRADE NON-HODGKINS-LYMPHOMA - RESULTS OF SWOG-8516 (INTERGROUP 0067), THE NATIONAL HIGH-PRIORITY LYMPHOMA STUDY

Background. CHOP is a four-drug, first-generation combination chemothe rapy regimen that has cured approximately 30% of all patients with adv anced stages of intermediate- or high-grade non-Hodgkin's lymphoma in national cooperative group trials. Initial single-institution studies of third-generation regimens such as m-BACOD, ProMACE-CytaBOM, and MAC OP-B suggested that 55%-60% of these patients might be cured. Patients and methods: In order to make a valid comparison between these regime ns, the Southwest Oncology Group and the Eastern Cooperative Oncology Group initiated a randomized phase III comparison of CHOP vs. m-BACOD vs. ProMACE-CytaBOM vs. MACOP-B. Endpoints of the study were response rate, time to treatment failure, overall survival, and severe or life- threatening toxicity. Received dose intensity calculations and subset analyses were also performed. Results: 1138 patients were registered o n this clinical trial. Each treatment arm contained between 218 and 23 3 eligible patients. Known prognostic factors were equally distributed . The initial results of this study were recently published [1]. There were no significant differences in either the partial or complete res ponse rates between treatment arms. Now after a median follow-up of 49 months and a maximum follow-up of 84 months, there is still no differ ence in time to treatment failure (p = 0.40) or overall survival (p - 0.68). No subset of patients was found to have significantly improved survival with the third-generation regimens. The received dose intensi ty data were comparable to previously published data for these regimen s. Fatal toxicity was 1% for CHOP, 3% for ProMACE-CytaBOM, 5% for m-BA COD, and 6% for MACOP-B. Conclusion: Based on similar failure-free and overall survival with lower cost and lower severe toxicity, CHOP rema ins the standard chemotherapy for patients with advanced-stage, interm ediate- or high-grade non-Hodgkin's lymphoma. New treatment strategies need to be developed to improve the prognosis of these patients.