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Dose-escalated cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide (CHOPE) chemotherapy for patients with diffuse lymphoma: Cancer and Leukemia Group B studies 8852 and 8854.

Publication ,  Journal Article
Bartlett, NL; Petroni, GR; Parker, BA; Wagner, ND; Gockerman, JP; Omura, GA; Canellos, GP; Robert, M; Johnson, JL; Peterson, BA
Published in: Cancer
July 15, 2001

BACKGROUND: To address the feasibility and outcome of moderate dose intensification with granulocyte-colony stimulating factor (G-CSF) for patients with aggressive non-Hodgkin lymphoma (NHL), the Cancer and Leukemia Group B (CALGB) conducted two studies evaluating dose-escalated cyclophosphamide and etoposide in the cyclophosphamide, doxorubicin, vincristine, prednisone, etoposide (CHOPE) regimen. METHODS: Eligibility criteria included histologically documented, diffuse small cleaved, diffuse mixed, diffuse large cell, or immunoblastic lymphoma, Stage III--IV or bulky Stage II disease, and an ECOG performance status of 0--1. CALGB 8852, a group-wide study, accrued 227 patients: 120 patients in the pilot study to determine the maximum tolerated dose (MTD) without G-CSF and 107 in the pilot study of dose-escalated CHOPE with G-CSF. CALGB 8854, a limited-institution, Phase I study, enrolled 38 patients and determined the MTD of CHOPE with G-CSF to be used in CALGB 8852. The MTD in both studies was defined as the dose at which 50% of patients had 1) Grade 4 neutropenia or thrombocytopenia lasting 7 days or more, or 2) Grade 3--4 hemorrhage or nonhematologic toxicity (excluding alopecia, nausea, and emesis), or 3) were prevented from receiving 100% of drug on Day 22. RESULTS: The MTD of CHOPE without G-CSF was cyclophosphamide 1000 mg/m(2) on Day 1 and etoposide 100 mg/m(2) on Days 1--3 with doxorubicin 50 mg/m(2) on Day 1, vincristine 1.4 mg/m(2) (maximum, 2 mg) on Day 1, and prednisone 100 mg on Days 1--5. With the addition of G-CSF at 200 microg/m(2) on Days 5--19, the MTD was cyclophosphamide 1500 mg/m(2) and etoposide 160 mg/m(2) on Days 1-3 with standard doses of doxorubicin, vincristine, and prednisone. Increasing the dose of G-CSF from 200 microg/m(2) to 400 microg/m(2) did not allow for further dose escalation. The primary toxicity in all cohorts was neutropenia. Four toxic deaths occurred on CALGB 8852. The 5-year failure free survival (FFS) and overall survival (OS) rates for eligible patients on CALGB 8852 were 31% (95% confidence interval [95%CI], 23--39) and 48% (95%CI, 40--57), respectively. The 5-year FFS and OS rates for eligible patients on CALGB 8854 were 34% (95%CI, 17--52) and 51% (95%CI, 33--70), respectively. CONCLUSIONS: Moderate dose escalation with G-CSF is feasible. However, response and survival rates of patients who receive dose-escalated CHOPE, even with the addition of G-CSF, appear similar to the rates reported with standard-dose CHOP.

Duke Scholars

Published In

Cancer

DOI

ISSN

0008-543X

Publication Date

July 15, 2001

Volume

92

Issue

2

Start / End Page

207 / 217

Location

United States

Related Subject Headings

  • Vincristine
  • Treatment Outcome
  • Prednisone
  • Oncology & Carcinogenesis
  • Neutropenia
  • Middle Aged
  • Male
  • Lymphoma, Non-Hodgkin
  • Lymphoma, Large-Cell, Immunoblastic
  • Lymphoma, Large B-Cell, Diffuse
 

Citation

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Bartlett, N. L., Petroni, G. R., Parker, B. A., Wagner, N. D., Gockerman, J. P., Omura, G. A., … Peterson, B. A. (2001). Dose-escalated cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide (CHOPE) chemotherapy for patients with diffuse lymphoma: Cancer and Leukemia Group B studies 8852 and 8854. Cancer, 92(2), 207–217. https://doi.org/10.1002/1097-0142(20010715)92:2<207::aid-cncr1311>3.0.co;2-d
Bartlett, N. L., G. R. Petroni, B. A. Parker, N. D. Wagner, J. P. Gockerman, G. A. Omura, G. P. Canellos, M. Robert, J. L. Johnson, and B. A. Peterson. “Dose-escalated cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide (CHOPE) chemotherapy for patients with diffuse lymphoma: Cancer and Leukemia Group B studies 8852 and 8854.Cancer 92, no. 2 (July 15, 2001): 207–17. https://doi.org/10.1002/1097-0142(20010715)92:2<207::aid-cncr1311>3.0.co;2-d.
Bartlett, N. L., et al. “Dose-escalated cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide (CHOPE) chemotherapy for patients with diffuse lymphoma: Cancer and Leukemia Group B studies 8852 and 8854.Cancer, vol. 92, no. 2, July 2001, pp. 207–17. Pubmed, doi:10.1002/1097-0142(20010715)92:2<207::aid-cncr1311>3.0.co;2-d.
Bartlett NL, Petroni GR, Parker BA, Wagner ND, Gockerman JP, Omura GA, Canellos GP, Robert M, Johnson JL, Peterson BA. Dose-escalated cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide (CHOPE) chemotherapy for patients with diffuse lymphoma: Cancer and Leukemia Group B studies 8852 and 8854. Cancer. 2001 Jul 15;92(2):207–217.
Journal cover image

Published In

Cancer

DOI

ISSN

0008-543X

Publication Date

July 15, 2001

Volume

92

Issue

2

Start / End Page

207 / 217

Location

United States

Related Subject Headings

  • Vincristine
  • Treatment Outcome
  • Prednisone
  • Oncology & Carcinogenesis
  • Neutropenia
  • Middle Aged
  • Male
  • Lymphoma, Non-Hodgkin
  • Lymphoma, Large-Cell, Immunoblastic
  • Lymphoma, Large B-Cell, Diffuse