Chemotherapy with etoposide, vincristine, doxorubicin, bolus cyclophosphamide, and oral prednisone in patients with refractory cutaneous T-cell lymphoma

BACKGROUND. This Phase II study was undertaken to assess the efficacy and t oxicity of chemotherapy with etoposide, vincristine, doxorubicin, bolus cyc lophosphamide, and oral prednisone (EPOCH regimen) in patients with advance d, refractory cutaneous T-cell lymphoma (CTCL). METHODS. Fifteen patients were treated with a 96-hour continuous infusion o f etoposide, vincristine, doxorubicin, bolus cyclophosphamide, and oral pre dnisone, followed by granulocyte-colony stimulating factor support and trim ethoprim/ sulfamethoxazole prophylaxis. The median age of the patients was 53 years (range, 17-82 years). Six patients had Sezary syndrome (SS), four patients had visceral involvement, and four patients had anaplastic large c ell morphology, three with Ki-1 (CD30) positivity. All patients had disease that was refractory to prior chemotherapy or electron beam irradiation and eight of these patients had received cyclophosphamide, doxorubicin, vincri stine, and prednisone. Seven patients had received prior interferon therapy and nine patients had received fludarabine and/or 2-CDA. RESULTS. After a median of 5 cycles (range, I-9 cycles), 4 patients achieve d a complete response (27%) and 8 patients achieved a partial response (53% ) for an overall response rate of 80% (95% confidence interval, 52-96%). Th ree patients with visceral involvement, two of three patients with anaplast ic large cell morphology, and one patient with human T-cell lymphoma virus leukemia/lymphoma did not respond. All 12 responders had improvement in ski n disease; 2 of 6 patients with SS had complete disappearance of circulatin g Sezary cells. The median progression free survival was 8.0 months (range, 3-22 months). After a median follow-up of 11.4 months (range, 2-56+ months ), the median patient survival was 13.5 months. Grade 3 or 4 hematologic to xicity occurred in 8 patients (61%); 5 of these 8 patients had febrile neut ropenia. Six patients developed staphylococcal bacteremia, two patients had disseminated herpes infection, and one patient had Pneumocystis carinii pn eumonia. Grade 3 neurotoxicity occurred in one patient. Two patients had a significant decrease in left ventricular ejection fraction and one patient had supraventricular tachycardia. CONCLUSIONS. EPOCH chemotherapy has a high response rate with acceptable to xicity in patients with advanced and refractory CTCL. Cancer 1999;86:1368-7 6. (C) 1999 American Cancer Society.