A randomized EPOCH vs. CHOP front-line therapy for aggressive non-Hodgkin's lymphoma patients: Long-term results

Background: The value of continuous-infusion chemotherapy (EPOCH) vs. the s tandard CHOP combination was evaluated in 78 patients with previously untre ated aggressive non-Hodgkin's lymphoma in a randomized phase III clinical t rial. Patients and methods: The EPOCH regimen given to 38 patients consisted of t he drugs etoposide (50 mg/m(2)), vincristine (0.4 mg/m(2)), and doxorubicin (10 mg/m(2)), all given in a continuous infusion on days 1-4. Cyclophospha mide (750 mg/m(2)) was administered on day 6 as i.v. bolus, while prednison e was given orally 60 mg/m(2) on days 1-6. Courses were repeated every thre e weeks. CHOP was given to 40 patients as routinely prescribed. Results: Forty-eight patients were males and thirty were females. Their age s ranged from 19-75 years (median 45 years). Forty-three (55%) had grade 2 and thirty-five (45%) had grade 3 pathologic subtype. Nine patients (12%) p resented with stage I, fourteen (18%) with stage II, forty (51%) with stage III, and fifteen (19%) with stage IV disease. The different clinico-pathol ogic characteristics, including international index categories, were compar able in the two groups. The number of courses given ranged between 3 and 9 (median 6) for both the EPOCH and CHOP regimens. Complete remission (CR) wa s achieved in 19 (50%), and 27 (67%) of the 38 and 40 patients for both the EPOCH and CHOP combinations, respectively. After a median observation time of 27 months, the four-year overall and failure-free survival rates were 4 2% and 30% for the EPOCH and 71% and 54% for the CHOP regimen (P = 0.006 an d 0.1 for the overall and FFS rates, respectively). Toxicities were compara ble and were mostly of grades 1 and 2, except for hair loss, hematologic to xicities, and infectious episodes which were more common in the EPOCH group . In the EPOCH group, overall survival rates were 55% vs. 22% (P < 0.04) at four years for the low-risk (2 prognostic factors) and high-risk (> 2 fact ors) groups, respectively. Conclusions: Thus, it may be concluded that continuous-infusion (EPOCH) che motherapy did not improve treatment outcome over that of the CHOP regimen f or aggressive non-Hodgkin's lymphoma patients.