ABVD regimen

A 34-year-old male with Hodgkin s disease is treated with the adri-amycin, bleomycin, vinblastine, and decarbazine (ABVD) regimen. What is the mechanism of action of vinblastine ... 

Several clinical trials have been performed to evaluate the efficacy of alternating or hybrid MOPP/ABVD regimens. The results of... 

Bleomycin is highly effective against germ cell tumors of the testis and ovary. In testicular cancer it is curative when used with cisplatin and vinblastine or cisplatin and etoposide. It is used as a component of the standard ABVD regimen for Hodgkin s disease. Bleomycin also is given intrapleurally (60 U)for malignant pleural effusions. 

Hodgkin s disease as part of the ABVD regimen. It causes alopecia, skin rash, gastrointestinal... 

Hodgkin s lymphoma ABVD regimen doxorubicin (Adriamycin) plus bleomycin plus vincristine plus dacarbazine... 

Clinical use Vincristine is a component of the MOPP and COP combination dmg regimens and is used in acute leukemias, lymphomas, Wilms tumor, and choriocarcinoma. Vinblastine is a component of the ABVD regimen for Hodgkin s disease and is used for other lymphomas, neuroblastoma, testicular carcinoma, and Kaposi s sarcoma. 

Clinical use Doxorubicin is a component of the ABVD regimen used in Hodgkin s disease and is used in treatment of myelomas, sarcomas, and breast, endometrial, lung, ovarian, and thyroid cancers. The main use of daunorubicin is in the treatment of acute leukemias. Idarubicin, a new anfhracycline, is approved for use in acute myelogenous leukemia. 

Items 11-12 A 23-year-old man with Hodgkin s disease was treated unsuccessfully with the MOPP regimen. He subsequently underwent a successful course of therapy with the ABVD regimen. 

Which one of the following classes of anticancer drugs used in the treatment of this patient is cell cycle-specific (CCS) and is used in both the MOPP and ABVD regimens ... 

During the second course of drug treatment (ABVD regimen), this patient developed dyspnea, a nonproductive cough, and intermittent fever. Chest x-ray revealed pulmonary infiltration. If these problems are due to the anticancer drugs that he has been exposed to, the most likely causative agent is... 

The cell cycle-specific drugs used in standard treatment protocols for Hodgkin s disease are bleomycin and the vinca alkaloids. Vinblastine is used in the ABVD regimen, and vincristine (Oncovin) is used in the MOPP regimen. The answer is (E). 

In an attempt to reduce relapse rate and late toxicity, combined-modality therapy using lower doses of radiation and an abbreviated course of chemotherapy has been evaluated.16 The goal of decreased relapse rate has been achieved, but no overall survival benefit has been documented. A limitation of this approach is exposing patients to the additive toxicities of chemotherapy. Trials that have investigated this approach typically have incorporated between two and four cycles of a standard regimen for HL, such as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) with involved-field radiation. At present, combined-modality therapy is considered to be a standard of care for stage I/II HL. 

More recently, a German study compared a dose-escalated regimen of BEACOPP (with filgrastim support) with standard-dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone, gemcitabine (BEACOPP) and COPP alternating with ABVD (C—cyclophosphamide instead of mechlorethamine for MOPP).18 The escalated BEACOPP was... 

The chemotherapy of advanced Hodgkin s disease is one of the best examples of successful combination chemotherapy. Combination therapy with the MOPP regimen (mechlorethamine, Oncovin [vincristine sulfate], procarbazine, prednisone), alternating with ABVD (Adriamycin [doxorubicin hydrochloride], bleomycin, vinblastine, dacarbazine), has resulted in cure rates of 50 to 60%. 

Chemotherapeutic Regimen ABVD Components of Regimen Doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velban), dacarbazine (DTIC) Primary Indication Hodgkin Disease... 

Bleomycin is a cytostatic drug that causes double-strand breaks in DNA. It has been used to treat Hodgkin s disease and a variety of solid cancers. It is often used in combination with other anticancer drugs, for example in the regimens known as ABVD (doxorubicin -r bleomycin -r vinblastine-r dacarbazine) and BEP (bleomycin-r etoposide -r cisplatin). It has also been injected intrapleu-rally in the management of malignant effusions. 

AR is a 48-year-old woman who was treated for Hodgkin s disease 15 years ago with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). She now presents with breast cancer and her oncologist feels that chemotherapy with FAC (fluorouracil, doxorubicin [Adriamycin], and cyclophosphamide) is the most appropriate regimen. Her previous chemotherapy included a total of 300 mg/m doxorubicin exposure. Which of the following agents may be utilized to reduce risk of cardiotoxicity associated with the anthracycline therapy she is about to receive ... 

The current NCCN guidelines recommend four to six cycles of combination chemotherapy, followed by involved-field radiation (30 to 36 Gy). ABVD is the most common regimen used, but other regimens can be used as an alternative to ABVD. 

In summary, alternating, hybrid, or sequential MOPP/AB VD (or MOPP/ABV) regimens have not been shown to be more effective than ABVD. ABVD has the advantage of less acute toxicity, no sterility. 

Diehl V, Franklin J, Hasenclever D, et al. BEACOPP, a new dose-escalated and accelerated regimen, is at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin s lymphoma interim report from a trial of the German Hodgkin s Lymphoma Study Group. J Clin Oncol 1998 16 3810-3821. 

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