HYBRID LOPP EVA IS NOT BETTER THAN LOPP ALTERNATING WITH EVAP - A PREMATURELY TERMINATED BRITISH NATIONAL LYMPHOMA INVESTIGATION RANDOMIZEDTRIAL

In a British National Lymphoma Investigation (BNLI) trial, patients wi th advanced Hodgkin's disease (stages IB, IIB, III, and IV) were rando mized between initial treatment with a LOPP alternating with EVAP regi men and a LOPP/EVA hybrid regimen. The two regimens contained identica l drug dosages and varied only in their scheduling. The complete remis sion (CR) rate in the hybrid regimen was significantly less than that in the alternating regimen, and the trial was terminated after approxi mately 18 months since there appeared to be no chance of the hybrid re gimen ever proving superior to the alternating regimen. A total of 160 patients were entered into the trial before recruitment was terminate d, 86 being randomized to the alternating regimen and 83 to the hybrid regimen. The CR rates for the alternating and hybrid arms were 65% an d 40%, respectively (p < 0.002). The CR relapse-free survivals at 2 ye ars in these two arms were 85% and 79%, respectively (p - 0.7); the ov erall disease-free survivals at 2 years were 57% and 32%; and the over all survivals at 2 years were 88% and 78% (p = 0.5). This trial emphas izes the impact of drug scheduling, which should be taken into account in the design of future hybrid regimens.