The CancerWeb Report, What's New In Cancer: May, 1996
Hodgkins' Disease

• Alternating drug regimens - Alternating treatment schedules have been used in cancer treatment, dermatology, and other medical areas for some time. The authors of a report from the National Tumor Institute in Milan, Italy, used this approach with two standard regimens for Hodgkins' disease. Between 1982 and 1990, they randomized 427 untreated patients to two different sequences of MOPP and ABVD (alternating full-cycle MOPP and ABVD, or a hybrid of one half-cycle of MOPP alternating with one half-cycle of ABVD within one month) for six cycles, followed by radiotherapy. The two regimens gave identical, superior results with complete remission rates of 91% versus 89%, freedom from regression rates of 675 and 69%, and overall survival rates of 74% versus 72%. The number of second malignancies reached 23 (6%). (Viviani, J Clin Oncol 14:1421, 1996)

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• Second malignancies - The chemotherapy agents used to treat Hodgkins' disease and other lymphomas include chemicals able to produce mutations, and thus theoretically able to cause cancer. When survival is short, possible induced cancers - second malignancies - are not a problem. However, success in treating leukemias and lymphomas leaves an increasing number of long term survivors and definitive cures. As a result we are seeing a low incidence of second neoplasms. A Scandinavian group reported on their findings in 1,641 patients treated between the 1940s or 1950s and 1991 for Hodgkins' disease at an early age (below 20). Among them there were 62 secondary neoplasms (3.8%), indicating a 7.7-fold increase in cancer risk. Cumulative risk rose with time, from 1.9% at 10 years to 6.9% at 20, and 18% at 30 years. The highest risks were for thyroid (33-fold increase) and breast (17-fold increment) cancers, and leukemia (17-fold increase). Breast cancer is the most important because of its much higher normal rate of occurrence. Sankila, J Clin Oncol 14:1442, 1996)