Endometrial cancer

Controversies in the therapy of acute myelogenous leukemia

Chemotherapy of advanced Hodgkin's disease.

Two chemotherapy regimens for treatment of patients with advanced Hodgkin's disease, BCVPP (carmustine, cyclophosphamide, vinblastine, procarbazine, and prednisone) and MOPP (mechlorethamine hydrochloride, vincristine, procarbazine, and prednisone), were compared in a randomized prospective study. Two hundred ninety-three patients were evaluable in the induction phase of this study. The complete remission rate with BCVPP was 76% (112/147) and with MOPP, 73% (106/146) (p = 0.51). The duration of complete remissions for previously untreated patients given BCVPP was significantly longer than that for previously untreated patients given MOPP (p = 0.02). Although hematologic toxicities were similar, BCVPP caused less gastrointestinal (p = 0.0001) and neurologic toxicity (p = 0.01) than MOPP. Previously untreated patients achieving complete remission with BCVPP survived significantly longer than those receiving MOPP (p = 0.03). As primary induction chemotherapy for advanced Hodgkin's disease, BCVPP is an effective alternative to MOPP, having equal or greater therapeutic benefit with less toxicity.

BCVPP chemotherapy for advanced Hodgkin's disease: evidence for greater duration of complete remission, greater survival, and less toxicity than with a MOPP regimen. Results of the Eastern Cooperative Oncology Group study.

Two chemotherapy regimens for treatment of patients with advanced Hodgkin's disease, BCVPP (carmustine, cyclophosphamide, vinblastine, procarbazine, and prednisone) and MOPP (mechlorethami...

BCVPP Chemotherapy for Advanced Hodgkin's Disease: Evidence for Greater Duration of Complete Remission, Greater Survival, and Less Toxicity Than with a MOPP Regimen

The purpose of this study is to see if immunotherapy with C. parvum and prevention of central nervous system relapse with intrathecal methotrexate can prolong duration of complete remission and survival as well as avoid central nervous system relapse. For induction, three weekly I.V. injections of vincristine and Daunorubicin were given with daily prednisone orally, followed by 5-day courses of Cytosine Arabinoside and 6-mercaptopurine. The patients were randomized to chemotherapy or chemoimmunotherapy. Maintenance consisted of vincristine, Daunorubicin, and prednisone one week every odd month, and a 5-day course of Cytosine Arabinoside and 6-mercaptopurine every even month. Every week, the chemoimmunotherapy group also received, without chemotherapy, one injection of C. parvum 4 mg, subcutaneously. All patients received five weekly injections of intrathecal methotrexate 13 mg/m2 right after complete remission was achieved. Out of 181 evaluable cases, 80 (44%) achieved complete remission, 45 were randomized to chemotherapy, and 35 to chemoimmunotherapy. In the chemoimmunotherapy group 32/35 relapsed, and in the chemotherapy group 36/45. Median duration of complete remission and survival were: for group chemotherapy, 8 and 15 months; for group chemoimmunotherapy, 5 and 10 months. This difference is not significant. Intrathecal methotrexate was given to all patients. Six patients (7%) had central nervous system leukemia at the time of the first injection. None had central nervous system relapse after prevention with intrathecal methotrexate. This method seems useful in preventing central nervous system relapse in patients with acute myeloblastic leukemia, but does not seem to prolong complete remission.

Chemoimmunotherapy with Corynebacterium parvum in acute myelocytic leukemia.

With the purpose of exploring new combinations less toxic and easier to manage, the Argentine Group for the Treatment of Acute Leukemia (GATLA) started a randomized controlled study to compare differences in efficacy of treatment in Hodgkin's disease using six courses of cyclophosphamide, vinblastine, procarbazine and prednisone (CVPP) versus the same drugs plus CCNU (CCVPP). A total of 298 patients entered this study; 157 with CVPP and 141 with CCVPP. No statistically significant difference was observed between both groups in each of the following features: prior therapy, sex, age, class, stage and histology. The doses in every monthly cycle are: cyclophosphamide 600 mg/m2 iv on day 1, vinblastine 6 mg/m2 iv on day 1, procarbazine 100 mg/m2/day 1 orally on day 1 to 14 and prednisone 40 mg/m2/day orally on day 1 to 14 in all the courses. The CCVPP group received also CCNU 75 mg/m2 day 1 orally on alternate cycles. Patients with stage I or II A received radiotherapy (4,000 rads) to involved areas as induction and were subsequently randomized to receive maintenance therapy. Patients in all other stages received only combination chemotherapy at random. Maintenance therapy consisted of one cycle every 2 months during the first year, every 4 months the second year and every 6 months the third year. Complete remission was obtained in 111 out of 157 patients (71%) of those receiving CVPP and in 110 out of 141 patients (78%) receiving CCVPP. There was no statistically significant difference between both regimens. The percentages of complete remission according to clinical stage and symptoms were: I-IIA 88%. III-IVA 84%, I-IIB 76%, IIIB 76% and IVB 58%. After 42 months of remaining in complete remission 53% and 64% of those patients were treated with CVPP or CCVPP, respectively. The survival percent as a function of therapeutic response at 48 months for patients who achieved complete remission was 80%, 63% for partial remission, and 14% for those who failed to respond or died within the first six courses, with a median duration of survival of 6 months.

Combined chemotherapy cyclophosphamide, vinblastine, procarbazine and prednisone (CVPP) V.S. CVPP PLUS CCNU (CCVPP) in Hodgkin's disease

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Chemoimmunotherapy with Corynebacterium parvum in acute myelocytic leukemia.

Combined chemotherapy cyclophosphamide, vinblastine, procarbazine and prednisone (CVPP) V.S. CVPP PLUS CCNU (CCVPP) in Hodgkin's disease