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Cancer
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Elyce Cardonick, Charlotte Maggen, Puja Patel
HDT is contraindicated during pregnancy due to significant risks of fetal toxicity. For relapsed HL in pregnancy, the gestational age, the status of the disease, and the first-line treatments previously given should all be taken into account. If the relapse occurs in early pregnancy, termination of the pregnancy might become unavoidable. During the second trimester, platinum and/or gemcitabine-based regimens may be considered. For recurrent disease presenting in the third trimester, administering a short course of ABVD awaiting delivery or late preterm delivery should be considered [65].
Nucleic Acids as Therapeutic Targets and Agents
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Given intravenously, the irritant properties of dacarbazine preclude contact with skin and mucus membranes. Also, because triazenes are prone to photochemical decomposition, an intravenous infusion bag containing dacarbazine must be protected from light. In the UK dacarbazine is used as a single agent to treat metastatic melanoma, and in combination with other agents for soft-tissue sarcomas and Hodgkin’s disease. In particular, it has been used as a component of a combination therapy for Hodgkin’s disease known as ABVD (doxorubicin [AdriamycinTM], Bleomycin, Vinblastine and Dacarbazine). Worldwide, it has also been used in a number of other cancer types including islet cell carcinoma of the pancreas. The predominant side effects are myelosuppression and intense nausea and vomiting.
Hodgkin Lymphoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Dennis A. Eichenauer, Andreas Engert
Given the poorer tumor control with ABVD when compared with escalated BEACOPP, studies using an ABVD backbone in combination with targeted drugs have been initiated recently. The ECHELON-1 study compared standard ABVD with a combination of AVD and the antibody-drug conjugate brentuximab vedotin (A-AVD). After a median follow-up of 24.6 months, the 2-year PFS was better for A-AVD (82.1% vs. 77.2%). However, this advantage in tumor control came at the cost of a significantly increased acute toxicity.24
Retrospective single-center experience with OEPA/COPDAC and PET-CT based strategy for pediatric Hodgkin lymphoma in a LMIC setting
Published in Pediatric Hematology and Oncology, 2022
Achanya Palayullakandi, Amita Trehan, Richa Jain, Rajender Kumar, Bhagwant Rai Mittal, Rakesh Kapoor, Radhika Srinivasan, Nandita Kakkar, Deepak Bansal
The treatment strategies and survival of HL in selected studies from LMIC are listed in Table 3. Among the several chemotherapy regimens, ABVD has commonly been used. There is a wide disparity in the administration of RT from a low of 17% to up to 100%. An earlier study in newly diagnosed patients with HL (n = 207) was reported from our center in 2013.4 Patients were administered various regimens, most commonly ABVD, COPP, or VAEP (vincristine, etoposide, doxorubicin, prednisolone). The five-year EFS and OS were 77.7% and 92.7%, respectively, with a relapse of 11.2%.4 The 4-year EFS and OS in the current study are 86.2 ± 3.4% and 93.5 ± 2.2%, respectively. With the current strategy, the survival compared favorably to the historical data. The relapses have reduced (6.3%) while omitting bleomycin and procarbazine and decreasing exposure to anthracyclines. In the PET-CT response adapted approach, RT was administered to a limited 19.5% of patients in the current study. We encourage colleagues in LMIC to consider a similar approach to achieve optimal survival while potentially lowering long-term toxicity. As the patients in LMIC tend to be younger, it is more appropriate to perform risk stratification with PET-CT to identify patients in whom RT can be safely omitted. However, a PET scan adds to the cost of treatment and may not be readily available in all centers in LMIC.
Cardiac conduction system exposure with modern radiotherapy techniques for mediastinal Hodgkin lymphoma irradiation
Published in Acta Oncologica, 2022
Pierre Loap, Alfredo Mirandola, Ludovic De Marzi, Viviana Vitolo, Amelia Barcellini, Alberto Iannalfi, Rémi Dendale, Youlia Kirova, Ester Orlandi
This retrospective observational study included patients treated at the Institut Curie (Paris, France) for localized unfavorable mediastinal HL with standard first line chemotherapy regimens (ABVD or BEACOPP) and subsequent consolidation irradiation with involved-site DIBH-VMAT, according to ILROG recommendations [8]. Radiotherapy records from thirty patients treated between January 2018 and May 2020 were selected from the institutional database by random sampling and anonymized. Median age of included patients was 30 years, 17 patients were women, and ECOG performance status ranged between 0 and 2. While all patients had intermediate stage HL according to EORTC criteria, eight patients initially presented with bulky disease. All patients had mediastinal disease, which was localized in the lower mediastinum (i.e., below the take-off of the left main stem coronary artery [12]) for 22 patients (73.3%) and limited to the upper mediastinum for eight patients (26.7%); 15 patients (50.0%) had additional neck targets and two patients (6.7%) axillary targets. ABVD regimen was delivered to 27 patients and the three other patients received BEACOPP chemotherapy. All patients received a consolidative dose of 30 Gy according to ESMO guidelines.
Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review
Published in Expert Review of Hematology, 2020
Mehul Dalal, Jatin Gupta, Kim Price, Athanasios Zomas, Harry Miao, Ajibade Ashaye
Although ABVD and BEACOPP are efficacious treatment options for advanced-stage HL, both are associated with several tolerability issues and short- and long-term side effects. The Skoetz review found that use of BEACOPP resulted in a statistically significant increase in incidence of AML and MDS (p = 0.02), and BEACOPPESC in an increase in Grade 3/4 hematological events compared with ABVD [6]. This was also true in the additional studies found in our review. Elderly patients treated with BEACOPPBASE had higher rates of Grade 4 acute toxicity vs ABVD/COPP [21]. Mounier et al., 2014 showed higher rates of anemia and leukopenia in the BEACOPP4+4 treatment group vs ABVD [46]. Chemotherapy-induced neutropenia is another common side-effect of HL treatment, and can result in dose-modifications or treatment delays [35,128]. One study reported neutropenia in 90% of patients treated with BEACOPP4+4 [84]. This compares with results from the Skoetz meta-analysis, in which patients treated with BEACOPPESC vs ABVD had a statistically significant increase in neutropenia (p < 0.0001) [6]. Risk of neutropenia can be managed using G-CSF [125], which in our review ranged from use as primary prophylaxis [19] and use with certain treatments such as BEACOPPESC [84], to secondary prophylaxis for patients with severe neutropenia [39]. ABVD and BEACOPP may also be associated with side effects not identified in this review. For example, alkylating agents in the BEACOPP regimen can affect fertility [129].