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'VEEP' in children with Hodgkin's disease--a regimen to decrease late sequelae
M E O'Brien1, C R Pinkerton, J Kingston
1Royal Marsden Hospital, Sutton, Surrey, UK.
Insights
A new chemotherapy regimen, VEEP, was tested in children with Hodgkin's disease (HD) to reduce long-term side effects. While showing promising initial response rates, the relapse-free survival appears lower than traditional treatments, requiring further investigation.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Pharmacology
Background:
- Hodgkin's disease (HD) treatment in children carries risks of secondary malignancies and infertility.
- Conventional chemotherapy regimens often utilize alkylating agents, contributing to long-term toxicities.
Purpose of the Study:
- To evaluate a novel anthracycline-based chemotherapy regimen (VEEP) for pediatric Hodgkin's disease.
- To assess the efficacy and safety of VEEP, aiming to minimize risks of second malignancies and infertility.
Main Methods:
- A pilot study involving 44 pediatric patients (aged 2-15 years) with Hodgkin's disease.
- Treatment consisted of vincristine, epirubicin, etoposide, and prednisolone (VEEP) administered every 3 weeks.
- Patients included previously untreated and relapsed cases, with a median follow-up of 25 months.
Main Results:
- Response rates were 80% in relapsed patients and 88% in previously untreated patients.
- Complete remission (CR) or unconfirmed CR (CR(u)) was achieved in 62% of untreated patients.
- The 3-year relapse-free survival rate was 67%, with some relapses observed in both CR and CR(u) groups.
Conclusions:
- The VEEP regimen demonstrates notable initial response rates in pediatric Hodgkin's disease.
- Event-free survival appears potentially lower compared to conventional combination therapies.
- Further follow-up is necessary to confirm the long-term outcomes and salvagability of relapsed patients treated with VEEP.
Abstract:
In an attempt to decrease the risk of second malignancies and future infertility in children with Hodgkin's disease (HD) while retaining acceptable remission rates, an anthracycline based regimen containing no alkylating agent has been devised. VEEP contains vincristine, epirubicin, etoposide and prednisolone given at 3 weekly intervals. Forty-four patients, aged 2-15 years, have been treated: ten relapsed patients and 34 previously untreated with chemotherapy (including three relapsed stage I treated initially with radiotherapy). The median follow up for all patients is 25 months (range 6-52 months). The response rate in previously treated patients was 80% (95% CI 44-97%) and five remain alive in remission. The response rate in untreated patients was 88% (95% CI 72-97%) with 62% CR + CR(u) (uncertain/unconfirmed) (95% CI 44-77%). Of four patients who had a final response of CR(u) three have relapsed at 9, 16 and 38 months. Two of the children in CR have relapsed at 6 and 16 months. The relapse free rate at 3 years is 67% (95% CI 17-82%). In this pilot study the event free survival appears somewhat poorer than conventional combinations and further follow up is required to confirm the salvagability of relapsed patients.