A phase II trial of teniposide (VM 26) in advanced non-Hodgkin's lymphoma, with emphasis on the treatment of elderly patients

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Abstract
Fifty‐four patients entered a phase II trial of teniposide (VM 26) in Stage III (35 patients) and stage IV (19 patients) non‐Hodgkin's lymphoma (NHL) classified according to modified Rappaport system. The median age was 71 years (range, 19–85). Thirty‐two patients were previously treated at least with combination chemotherapy and radiotherapy, whereas 22 were elderly (range, 70–85 years) untreated patients with a median Karnofsky score of 70. VM 26 was given by IV infusion at 100 mg/m2 weekly for at least 3 doses in “unfavorable” histologic subtypes, and for at least 6 to 9 doses in “favorable” subtypes, prior to the evaluation of response. The overall objective response rate was 43% in the 51 evaluable patients. The median duration of the 12 complete responses (CRs) was 7+ months (26+ to 2). According to the histology, VM 26 was very effective in the six patients with diffuse “histiocytic” (DH) subtype (four CRs, one partial response [PR]), and in the 8 patients with mycosis fungoides (MF) (two CRs, two PRs). Diffuse lymphocytic poorly differentiated and lymphoblastic NHL were less sensitive subtypes to VM 26. Among the 20 evaluable elderly patients a 50% objective response rate was obtained with five CRs. Four CRs and one PR were obtained in the five patients with DH subtype; no response was obtained in the only patient with MF. Toxicity, usually hematologic, was mild, even in elderly patients; neurotoxicity occurred in four instances. VM 26 seemed to be an effective and well‐tolerated drug in advanced NHL; this drug should be further evaluated as first line chemotherapy in elderly (⩾70 years) previously untreated patients with poor general conditions and DH histology.