Chemotherapy Regimens Mopp and MOPP derivatives

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The dosage, schedule, and frequency of MOPP chemotherapy are described in Table 73.6. Patients receive four drugs over a 2-week interval followed by a 2-week recovery period. A total of 4 weeks constitutes one cycle of treatment. Most patients receive six cycles. Historically, the dose of vincristine used in MOPP frequently exceeded the currently recognized dosage limit of 2 mg. Two updated mature studies with 1045 and 14 years46 follow-up, respectively, showed that 66% of patients have remained disease-free more than 10 years from the end of treatment. Forty-eight percent of advanced HL patients have survived between 9 and 21 years (median, 14 years) from the end of treatment. Nineteen percent of the complete remission cases have died of intercurrent illnesses, free of HL.45'46

Unfortunately, acute and long-term toxicities of MOPP regimen were significant. These toxicities ranged from nausea to death. Overall mortality approached 2.5% in the NCI series and 1.5% in smaller studies.47 Hematologic toxicities, although reversible, were sometimes fatal, as hematopoietic growth factor compounds were not available at that time. Vincristine-associated neuropathy was clinically relevant with doses more than 2 mg. Procarbazine was associated with severe emesis, and a type I allergic reaction in rare cases.

Long-term toxicities were of even more serious concern. Most patients experienced infertility after treatment with MOPP. Males had at least an 80% risk of permanent azospermia after MOPP, while 50% of females experienced gonadal failure.4748 The risk appeared lower with patients younger than 25 years of age; however, accelerated early menopause seemed to be the case in every female who did recover her menses after treatment.46 At a time when sperm banking and oocyte cryopreservation were in their early stages, many young patients, though cured, experienced significant psychological repercussions due to their infertility.

Another major problem with MOPP was the observation of myelodysplastic syndrome (MDS) and acute leukemia in up to 6% of patients. These hematologic malignancies started 2 years after treatment, with a

Table 73.6 Main chemotherapy regimens used in advanced HL

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