Journal of Clinical Oncology, Vol 11, 1573-1582, Copyright © 1993 by American Society of Clinical Oncology
EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma
WH Wilson, G Bryant, S Bates, A Fojo, RE Wittes, SM Steinberg, DR Kohler, ES Jaffe, J Herdt and BD Cheson
Medicine Branch, National Cancer Institute, Bethesda, MD 20892.
PURPOSE: Based on in vitro evidence that tumor cells are less resistant to
prolonged exposure to low concentrations of the natural product class,
compared with brief higher concentration exposure, we developed a
chemotherapy regimen (etoposide, vincristine, doxorubicin,
cyclophosphamide, and prednisone [EPOCH]) in which the natural products are
administered as a continuous infusion. PATIENTS AND METHODS: This is a
phase II study of etoposide, vincristine, and doxorubicin, administered as
a 96-hour continuous infusion, with intravenous (IV) bolus cyclophosphamide
and oral prednisone (EPOCH) in 74 consecutive patients who relapsed from or
failed to respond to most of the same drugs administered on a bolus
schedule. Patients with aggressive lymphomas who achieved a good response
after EPOCH were eligible to undergo bone marrow transplantation. RESULTS:
Patients with intermediate- or high-grade lymphoma comprised 76% of this
series and 77% had stage IV disease. Seventy-one percent had previously
received all of the drugs contained in the EPOCH regimen and 92% had
received at least four of the drugs. Seventy patients were assessable for
response, of whom 19 (27%) achieved a complete remission (CR) and 42 (60%)
a partial remission (PR). Among 21 patients who had no response to prior
chemotherapy, 15 (71%) responded, but only one achieved a CR. Patients who
relapsed from an initial CR had a 100% response rate, with 76% CRs. With a
median potential follow-up duration of 19 months, there was a 28%
probability of being event-free at 1 year. Toxicity was primarily
hematologic with neutropenia during 51% of cycles, but only a 17% incidence
of febrile neutropenia. Gastrointestinal, neurologic, and cardiac toxicity
were minimal. CONCLUSION: EPOCH chemotherapy was well tolerated and highly
effective in patients who were resistant to or relapsed from the same drugs
administered on a bolus schedule, suggesting that continuous infusion of
the natural drug component of this regimen is capable of partially
reversing drug resistance and reducing toxicity. Dose-intensity (DI) was
> or = that achieved in primary treatment regimens for aggressive
lymphomas.
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Facebook  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
T. Numbenjapon, J. Wang, D. Colcher, T. Schluep, M. E. Davis, J. Duringer, L. Kretzner, Y. Yen, S. J. Forman, and A. Raubitschek
Preclinical Results of Camptothecin-Polymer Conjugate (IT-101) in Multiple Human Lymphoma Xenograft Models
Clin. Cancer Res.,
July 1, 2009;
15(13):
4365 - 4373.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Jermann, L. M. Jost, Ch. Taverna, E. Jacky, H. P. Honegger, D. C. Betticher, F. Egli, Th. Kroner, and R. A. Stahel
Rituximab-EPOCH, an effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study
Ann. Onc.,
March 1, 2004;
15(3):
511 - 516.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Hamlin, A. D. Zelenetz, T. Kewalramani, J. Qin, J. M. Satagopan, D. Verbel, A. Noy, C. S. Portlock, D. J. Straus, J. Yahalom, et al.
Age-adjusted International Prognostic Index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma
Blood,
September 15, 2003;
102(6):
1989 - 1996.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Kataoka, F. Arima, J. Nishimoto, T. Watanabe, Y. Kobayashi, R. Tamura, S. Yamamoto, Y. Matsuno, T. Shimoda, and K. Tobinai
Enteropathy-type T-cell Lymphoma Showing Repeated Small Bowel Rupture and Refractoriness to Chemotherapy: a Case Report
Jpn. J. Clin. Oncol.,
December 1, 2002;
32(12):
546 - 549.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Saito, Y. Matsuno, R. Tanosaki, T. Watanabe, Y. Kobayashi, and K. Tobinai
{gamma}{delta} T-cell neoplasms: a clinicopathological study of 11 cases
Ann. Onc.,
November 1, 2002;
13(11):
1792 - 1798.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Sparano, E. Weller, T. Nazeer, T. Habermann, A. E. Traynor, J. Manalo, and P. Cassileth
Phase 2 trial of infusional cyclophosphamide, doxorubicin, and etoposide in patients with poor-prognosis, intermediate-grade non-Hodgkin lymphoma: an Eastern Cooperative Oncology Group trial (E3493)
Blood,
August 13, 2002;
100(5):
1634 - 1640.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. T. Stokoe, J. Ogden, and V. K. Jain
Activity of Infusional Etoposide, Vincristine, and Doxorubicin with Bolus Cyclophosphamide (EPOCH) in Relapsed Hodgkin's Disease
Oncologist,
October 1, 2001;
6(5):
428 - 434.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Stewart, V Malkovska, J Krishnan, L Lessin, and W Barth
Lymphoma in a patient with rheumatoid arthritis receiving methotrexate treatment: successful treatment with rituximab
Ann Rheum Dis,
September 1, 2001;
60(9):
892 - 893.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. F. Little, M. Gutierrez, E. S. Jaffe, A. Pau, M. Horne, and W. Wilson
HIV-Associated Non-Hodgkin Lymphoma: Incidence, Presentation, and Prognosis
JAMA,
April 11, 2001;
285(14):
1880 - 1885.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. R. Gaynor, J. M. Unger, T. P. Miller, T. M. Grogan, L. A. White Jr, G. M. Mills, S. P. Balcerzak, M. Varterasian, M. LeBlanc, and R. I. Fisher
Infusional CHOP Chemotherapy (CVAD) With or Without Chemosensitizers Offers No Advantage Over Standard CHOP Therapy in the Treatment of Lymphoma: A Southwest Oncology Group Study
J. Clin. Oncol.,
February 1, 2001;
19(3):
750 - 755.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gutierrez, B. A. Chabner, D. Pearson, S. M. Steinberg, E. S. Jaffe, B. D. Cheson, A. Fojo, and W. H. Wilson
Role of a Doxorubicin-Containing Regimen in Relapsed and Resistant Lymphomas: An 8-Year Follow-Up Study of EPOCH
J. Clin. Oncol.,
November 1, 2000;
18(21):
3633 - 3642.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Kewalramani, A. D. Zelenetz, E. E. Hedrick, G. B. Donnelly, S. Hunte, A. C. Priovolos, J. Qin, N. C. Lyons, J. Yahalom, S. D. Nimer, et al.
High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis
Blood,
October 1, 2000;
96(7):
2399 - 2404.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Petak, D. M. Tillman, F. G. Harwood, R. Mihalik, and J. A. Houghton
Fas-dependent and -independent Mechanisms of Cell Death following DNA Damage in Human Colon Carcinoma Cells
Cancer Res.,
May 1, 2000;
60(10):
2643 - 2650.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
W. H. Wilson, L. Sorbara, W. D. Figg, E. K. Mont, E. Sausville, K. E. Warren, F. M. Balis, K. Bauer, M. Raffeld, A. M. Senderowicz, et al.
Modulation of Clinical Drug Resistance in a B Cell Lymphoma Patient by the Protein Kinase Inhibitor 7-Hydroxystaurosporine: Presentation of a Novel Therapeutic Paradigm
Clin. Cancer Res.,
February 1, 2000;
6(2):
415 - 421.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
P. C. Bishop, W. H. Wilson, D. Pearson, J. Janik, E. S. Jaffe, and P. C. Elwood
CNS Involvement in Primary Mediastinal Large B-Cell Lymphoma
J. Clin. Oncol.,
August 1, 1999;
17(8):
2479 - 2479.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. A. Mickley, J.-S. Lee, Z. Weng, Z. Zhan, M. Alvarez, W. Wilson, S. E. Bates, and T. Fojo
Genetic Polymorphism in MDR-1: A Tool for Examining Allelic Expression in Normal Cells, Unselected and Drug-Selected Cell Lines, and Human Tumors
Blood,
March 1, 1998;
91(5):
1749 - 1756.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. H. Sehn, J. H. Antin, L. N. Shulman, P. Mauch, A. Elias, M. E. Kadin, and C. Wheeler
Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome Following High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation
Blood,
January 15, 1998;
91(2):
717 - 723.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. H. Wilson, J. Teruya-Feldstein, T. Fest, C. Harris, S. M. Steinberg, E. S. Jaffe, and M. Raffeld
Relationship of p53, bcl-2, and Tumor Proliferation to Clinical Drug Resistance in Non-Hodgkin's Lymphomas
Blood,
January 15, 1997;
89(2):
601 - 609.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. E. Bates, W. H. Wilson, A. T. Fojo, M. Alvarez, Z. Zhan, J. Regis, R. Robey, C. Hose, A. Monks, Y. K. Kang, et al.
Clinical Reversal of Multidrug Resistance
Oncologist,
August 1, 1996;
1(4):
269 - 275.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Andersen
Response of Resistant Idiopathic Thrombocytopenic Purpura to Pulsed High-Dose Dexamethasone Therapy
N. Engl. J. Med.,
June 2, 1994;
330(22):
1560 - 1564.
[Abstract]
[Full Text]
|
|
|
|
