Combination chemotherapy of advanced previously treated Hodgkin's disease with streptozotocin, CCNU, adriamycin and bleomycin

Abstract

Seventeen patients with advanced, previously treated Hodgkin's disease received therapy with a combination of streptozotocin 500 mg/m² /day i.v. days 1–5, CCNU 100 mg/m² orally day 1, adriamycin 45 mg/m² i.v. day 1, and bleomycin 15 mg/m² i.m. days 1 and 8 at 28‐day intervals (SCAB). The overall response rate was 59% with six patients (35%) achieving complete remission and four patients (24%) entering partial remissions. No maintenance therapy was given and the median duration of complete remission was 8+ months (range 2+–18+ months), while the median duration of partial remission was only 2 months (range 2–3 months). The median duration of survival from the start of therapy for the complete responders was 16+ months (range 5+–25+ months) while the median survival for the partial and nonresponders was only 5 months (range 2–13 and 3–11+ months, respectively). Toxicity was a major problem with this drug combination. Myelosuppression occurred regularly and was severe after 25% of courses. There were two death directly related to drug‐induced myelosuppression. Other serious toxicities included bleomy cin‐induced pulmonary toxicity in three patients, with one death; renal tubular dysfunction secondary to streptozotocin in three patients; hepatic dysfunction in three patients and severe weight loss in three patients. SCAB has proven to be an active although toxic combination which is not cross‐resistant to MOPP‐type regimens. Alterations in drug dosages and scheduling are being evaluated in an effort to ameliorate toxicity and preserve efficacy.