Comparison of the use of teniposide and vincristine in combination chemotherapy for non-Hodgkin's lymphoma.

A total of 164 patients with non-Hodgkin's lymphoma (NHL) were randomized to receive cycles of treatment every 3 weeks with either CTP, ie, cyclophosphamide (400 mg/m2/day orally X 5), teniposide (VM-26) (100 mg/m2 iv X 1), and prednisolone (60 mg/m2/day orally X 5), or COP, ie, vincristine (1.4 mg/m2 iv X 1; maximum, 2 mg) with the same cyclophosphamide and prednisolone doses listed above. Results were analyzed according to whether the patients' NHL histology was favorable (47 patients) or unfavorable (117). The great majority of patients in each group had advanced disease (stage IV in 70% and stage III in 20%). For each histologic group, the results with the two regimens were similar with respect to remission incidence and survival. In favorable-histology NHL, CTP produced 57% complete remissions (CR) and 29% partial remissions (PR), compared with 54% CR and 19% PR for COP. Survival in these patients was also similar for the two regimens, the relative death rates being 1.13 for CTP-treated patients and 0.88 for COP-treated patients (P = 0.75). In patients with unfavorable-histology NHL, CTP produced 38% CR and 28% PR, compared with 43% CR and 35% PR for COP, the relative death rates being 1.10 for CTP-treated patients and 0.90 for COP-treated patients (P = 0.49). Neurotoxicity was virtually absent in patients treated with CTP, whereas in COP-treated patients it was severe in 12% and moderate in 36%. Other toxic effects occurred with equivalent frequency in the two regimens. These results show that teniposide can replace vincristine in combination with cyclophosphamide and prednisolone in the treatment of NHL, with freedom from neurotoxicity and comparable survival and response rates.