Pirarubicin, A Novel Derivative of Doxorubicin THP-COP Therapy for Non-Hodgkinʼs Lymphoma in the Elderly

Pirarubicin (tetrahydropyranyl adriamycin, THP) is a derivative of doxorubicin. Forty-three non-Hodgkin's lymphoma (NHL) patients 65 years of age or older were treated with a combination therapy including cyclophosphamide (CPA), vincristine (VCR), prednisone (PSL), and THP (THP-COP). The THP-COP regimen consisted of THP, 30 mg/m2 i.v. on day 1; CPA, 500 mg/m2 i.v. on day 1; VCR, 1.0 mg/m2 i.v. on day 1; and PSL, 60 mg orally for 5 consecutive days. The sequence was repeated at 21- to 28-day intervals for a minimum of four cycles. Of the 43 patients, 13 (30.2%) achieved a complete response (CR) and 21 (48.8%) a partial response (PR). Nine patients (21.0%) had primary treatment failure, which included a minimal response, no change, and progressive disease. Thus, the response rate (CR or PR) was 79.1%. Twenty-six of 29 previously untreated patients (89.7%) achieved a CR or PR, whereas only 8 of 14 previously treated patients (57.1%) did (p less than 0.05). Because THP is a derivative of doxorubicin, the results for the eight patients previously treated with doxorubicin are noteworthy; four achieved a CR or PR. No patients had any cardiac toxicity, including congestive heart failure, attributable to THP. Furthermore, four patients who showed a decreased ejection fraction before treatment completed the full course of THP-COP chemotherapy without any progression of the cardiac complication. THP is considered to be active against NHL in the elderly and comparable to doxorubicin in combination chemotherapy.