Oral agents administered in combination on a daily basis may theoretically maintain continuous serum drug levels sufficient to override at least one mechanism of drug resistance characterized by over-expression of MDR-1. Since 1991, 52 chemotherapy-refractory/relapsed Hodgkin's Disease and Non-Hodgkin's lymphoma patients have been treated with the PEP-C (C3) program- All patients were heavily pretreated, with 42 (81%) having received three or more prior regimens. All had prior IV bolus alkylating agents, doxorubicin, and/or etoposide.

The PEP-C regimen consisted of:

oral prednisone 20 mg each AM
oral cyclophosphamide 50 mg (or chlorambucil 2 mg) each afternoon
oral etoposide 50 mg each evening 
and oral procarbazine 50 mg at bedtime (with an oral anti-emetic)

All medications were administered on a daily basis until the WBC was less than 3000/di, then treatment was held until recovery from nadir occurred. Therapy was then re-instituted on a daily, alternate day, or fractionated weekly basis (e.g. 5n days) depending on patient tolerance. Doses given per day were held constant. 

Thirty-three of 52 patients (63%) achieved a significant response consisting of 20 CRs (38%) and 13 PRs (25%)- Minor responses occurred in 9 (17%). Responses by histology were as follows:

follicular 12/14 (86%)
mantle cell 6/7 (86%) 
marginal zone 5/9 (56%)
small lymphocytic 3/6 (50%)
Hodgkin's 3/6 (50%)
diffuse large cell 3/8 (36%)
T cell 1/2 (50%)

Return to top