25 maart 2005: Bron: Medscape

Een chemocombinatie van doxorubicin, cyclophosphamide, vindesine, bleomycin, en prednisone (ACVBP) geeft significant betere resultaten - langere overlevingstijd en langere periode van ziektevrije tijd - dan de chemocombinatie cyclophosphamide, doxorubicin, vincristine, en prednisone (CHOP) plus radiotherapie - bestraling voor behandeling van gelokaliseerde aggressieve lymfklierkanker. Dit blijkt uit een grote tienjarige gerandomiseerde dubbelblinde studie bij 647 lymfklierpatiënten met stadium I en II jonger dan 61 jaar bij diagnose. De onderzoekers pleiten nu voor verder onderzoek naar effect van ACVBP regime gekoppeld aan Mabthera om zo de overlevingstijd en ziektevijre periode nog langer te maken. Onze tip: gebruik van bepaalde extra voeding en voedingstoffen bij lymfklierkanker, zowel ziekte van Hodgkin als non-Hodgkin lijkt n.a.v. verhalen van lymfklierkankerpatiënten een uitstekende aanvulling om de ziekte zo lang mogelijk onder controle te houden of wellicht helemaal te niet te doen.

Hier zo goed als letterlijk vertaald de resultaten uit de fase III studie:

Ziektevrije tijd en overall overlevingscijfers waren hoger in de ACVBP groep dan in de CHOP plus bestralingsgroep. (P < .001 voor beide). De vijfjaars ziektevrije tijd was 82% (95% confidence interval , 78%-87%) voor de ACVBP groep, en 74% (95% CI, 69%-78%) voor de CHOP groep. Voor de overall overleving, de vijfjaars overleving was 90% (95% CI, 87%-93%) en 81% (95% CI, 77%-86%), respectievelijk. Multivariabele analyses toonden aan dat de resultaten onafhankelijk waren van tumorstadium en de aan- of afwezigheid van 'bulky' ziekteverschijnselen. Wij denken dat ze met 'bulky' bedoelen dat er meerdere lymfklieren al of niet zijn aangetast, maar we zullen dit nog navragen bij deskundige. Hier een artikel uit Medscape over deze fase III studie.

March 23, 2005 — The chemotherapy regimen consisting of dose-intensified doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) is better than cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus radiotherapy for treating localized aggressive lymphoma, according to the results of a randomized trial published in the March 24 issue of the New England Journal of Medicine.

"Chemoradiotherapy is standard treatment for localized aggressive lymphoma," write Félix Reyes, MD, from the Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, and colleagues from the Groupe d'Etude des Lymphomes de l'Adulte (GELA). "In a previous study of two chemotherapy regimens for intermediate or high-grade lymphoma, the estimated five-year rate of overall survival among patients with localized disease who received the ACVBP regimen was 80%, which is similar to results in other trials that used chemoradiotherapy."

In this study, previously untreated patients younger than 61 years with localized stage I or II aggressive lymphoma and no adverse prognostic factors based on the International Prognostic Index (IPI) were randomized to receive three cycles of CHOP plus involved-field radiotherapy (n = 329) or chemotherapy alone with ACVBP plus sequential consolidation (n = 318). Median follow-up was 7.7 years.

Event-free and overall survival rates were higher in the ACVBP group than in the CHOP plus radiotherapy group (P < .001 for both). The five-year estimates of event-free survival were 82% (95% confidence interval , 78%-87%) for the ACVBP group, and 74% (95% CI, 69%-78%) for the CHOP group. For overall survival, the five-year estimates were 90% (95% CI, 87%-93%) and 81% (95% CI, 77%-86%), respectively. Multivariate analysis revealed that treatment group affected event-free and overall survival rates independently of tumor stage and the presence or absence of bulky disease.

"In patients under 61 years of age, chemotherapy with three cycles of ACVBP followed by sequential consolidation is superior to three cycles of CHOP plus radiotherapy for the treatment of low-risk localized lymphoma," the authors write. "Efforts are now needed to further improve event-free survival among such patients. Given the benefit of the combination of rituximab and chemotherapy, the GELA has undertaken a trial of rituximab plus the ACVBP regimen in young adults with localized low-risk aggressive lymphoma."

The Programme Hospitalier de Recherche Clinique du Ministère de la Santé and grants from Amgen, Roche, Schering-Plough, maker of prednisone, and Astra-Medica supported this study.

In an accompanying editorial, James O. Armitage, MD, from the University of Nebraska Medical Center in Omaha, wonders if the addition of adjuvant radiotherapy or rituximab would have changed the results. Dr. Armitage notes that approximately 20% of patients treated with ACVBP and more than 25% of those treated with CHOP plus radiotherapy were not cured.

"As the concept of staging continues to evolve, multiple factors other than the Ann Arbor stage will be important in predicting prognosis and choosing treatment for patients with aggressive non-Hodgkin's lymphoma," Dr. Armitage writes. "Physicians who treat patients with lymphomas hope that we will continue to move away from the 'one-size-fits-all' approach to the management of aggressive lymphomas."

Dr. Armitage has received consulting fees from GlaxoSmithKline, Corixa, and Geneotope and lecture fees from Genentech, maker of rituximab, Corixa, GlaxoSmithKline, and Amgen.

N Engl J Med. 2005;352:1197-1205, 1250-1252

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