Cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide (CHOPE) for advanced-stage Hodgkin's disease: CALGB 8856

Successful treatment of advanced-stage Hodgkin's disease (HD) may criticall y depend on dose intensity. Because mechlorethamine, Oncovin, procarbazine, and prednisone (MOPP), aid Adriamycin, bleomycin, vinblastine, and dacarba zine (ABVD) are not suitable for major dose escalation, we evaluated the ac tivity and toxicity of combined cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide (CHOPE) in advanced HD, here used at conventiona l dose intensity, as a preparatory study prior to using this regimen at hig her dose intensity. Ninety-two patients were treated with CHOPE (cyclophosp hamide, 750mg/m(2), day 1; doxrudicin, 50mg/m(2), day 1; vincristine, 1.4mg /m(2), day 1 and 8; prednisone, 100 mg/day, days 1-5; and etoposide, 80 mg/ m(2), days 1, 2, and 3) every 21 days. All had advanced HD with no prior ch emotherapy with 46% stage IV, 63% with B symptoms, and 57% with bulky disea se (>5 cm). Radiation and growth factor support were not permitted. Full-do se vincristine (not capped at maximum 2 mg/dose) was used in the first 33 p atients. An initial cohort of 41 patients was treated with four cycles of C HOPE to evaluate safety and efficacy followed by four cycles of ABVD. A sec ond cohort of 51 patients was treated with 6-8 cycles of CHOPE alone. Toxic ity was generally acceptable and primarily hematologic, with neutrophils < 500 in 63% of cohort I and 90% of cohort II, and platelets < 25,000 in 7% o f cohort I and 8% of cohort II. The long-term neurotoxicity of full-dose, h igh-intensity vincristine was acceptable and largely reversible. In cohort I, 92% of patients achieved a complete response (CR) or partial response (P R) with four cycles of CHOPE and 85% were in CR after four additional cycle s of ABVD. In cohort II, 77% achieved a CR with 6-8 cycles of CHOPE alone. FFS was 76% in cohort I and 59% in cohort II, with a median follow-up of 8. 2 and 5.7 years, respectively. CHOPE, at conventional close intensity as us ed here, is an effective first-line regimen for the treatment advanced-stag e HD and may warrant evaluation using higher closes of cyclophosphamide and etopaside with granulocyte colony stimulating factor (G-CSF) support.