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Mitoxantrone, vinblastine, and lomustine (CCNU) (MVC): a highly active regimen for advanced and poor-prognosis
P H Wiernik1, J P Dutcher, A I Einzig
1Albert Einstein Cancer Center, Montefiore Medical Center, Bronx, NY 10467, USA.
Purpose:
A new regimen, MVC (mitoxantrone, vinblastine, and CCNU [lomustine]), was studied in advanced Hodgkin's disease. This regimen combines the most effective elements of previous regimens for poor-prognosis Hodgkin's disease and eliminates agents with unnecessary toxicities and marginal activity. Initially, patients with relapsed or refractory disease were entered, and after substantial activity was observed, patients with advanced-stage, newly diagnosed Hodgkin's disease were also treated.
Patients And Methods:
Thirty-six relapsed or refractory patients were entered on this study. Prior treatment included radiotherapy alone (three patients), combined-modality treatment (n = 21), and single (n = 2) or multiple chemotherapy regimens (n = 10). Seventeen advanced-stage (bulky IIB-IVB) newly diagnosed Hodgkin's patients were also entered, with a median follow-up of 7 years.
Results:
Thirty-two of 36 (88%) relapsed/refractory patients responded to MVC, with 18 partial responses (50%) and 14 complete responses (39%). Median complete response duration is 20 months (range, 2 to 108+ months). The median survival of all previously treated MVC patients is 28 months (range, 4 to 127+ months). Eleven of 32 previously treated MVC responders remain alive and disease-free at 12 to 127+ months, seven after autologous bone marrow transplantation (12 to 127+ months) and four after MVC without transplantation (31 to 113+ months). Thirteen of 17 advanced-stage, newly diagnosed Hodgkin's disease patients achieved a complete response and four achieved a partial response to MVC (100% response rate). Two complete response and all partial response patients have relapsed. Eight complete responses are ongoing at 11 to 114+ months. Three patients died in complete response at 11, 42, and 43 months. Median response duration has not been reached.
Discussion:
MVC is a highly active regimen in relapsed and advanced-stage Hodgkin's disease, with outcome results comparable to other established regimens. Treatment is associated with myelosuppression but is otherwise well tolerated. MVC provides an effective alternative regimen for newly diagnosed patients with Hodgkin's disease and an effective salvage regimen for patients previously treated with anthracyclines.