IGEV Salvage Chemotherapy for Relapsed Hodgkin's

Nobody can deny the enormous strides in the treatment of Hodgkin's lymphoma. What used to be the equivalent of a death sentence now has a cure rate that in many cases approaches 90 percent.

However, approximately ten percent of Hodgkin's patients who receive standard frontline therapy (which in the United States involves the ABVD regimen, but elsewhere might involve the BEACOPP or Standford V regimen) are not cured. Researchers and oncologists have a difficult time treating this ten percent, and they are always looking tor some sort of biomarker that might indicate to them beforehand whether or not the patient will respond to standard frontline therapy. So far such a biomarker has not been identified.

Salvage Treatment

When frontline treatment of Hodgkin's lymphoma fails or results in only a partial response, the next step is to discuss salvage therapy.

Since the 1990s, the gold standard for patients with relapsed or refractory Hodgkin's lymphoma has been salvage chemotherapy followed by high dose chemotherapy with autologous bone marrow/peripheral blood stem cell transplant. It has been determined that this treatment can produce long-term remission in about half of all relapsed patients.

While several prognostic factors have been identified that can indicate what the chances are that salvage therapy will work, one issue that remains unanswered is which standard-dose chemotherapy regimen to use that will provide the best outcome for the patient.

IGEV Salvage Therapy

There are many options available to doctors treating patients with relapsed Hodgkin's lymphoma in terms of combination salvage chemotrherapy. A rather recently introduced regimen is IGEV. The drugs used in IGEV are as follows:

• Ifosfamide
• Gemcitabine
• Vinorelbine
• Prednisone

Established by Armando Santoro MD, of the Department of Medical Oncology and Hematology, Instituto Clinico Humanitas in Milan, and colleagues, IGEV's efficacy in this setting was first tested by this team and reported in 2007.

Their study involved 91 patients with refractory or relapsed Hodgkin's treated with IGEV. Their results demonstrated that over half of patients (49) achieved a complete response to therapy, with another 25 patients achieving partial response. The treatment had a low toxicity profile, high response rate, and it had a very high mobilizing potential in terms of cell mobilization for an autologous stem cell transplantation.

Treatment typically involves four cycles of this salvage therapy prior to having peripheral blood stem cells harvested.

Sources
Santoro A et al. Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin’s lymphoma. Haematologica. 2007 Jan;92(1):35-41.