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HFM - 003531 Questions and Answers on Cancer Phenyl-beta-naphthylamine Hodgkin's Disease Recent investigations have disclosed that phenyl-beta-naphthylamine can undergo N-dephenylation in humans, with recovery ofsmall amounts of beta-naphthylamine, a potent carcinogen, in the urine of ex posed subjects. Has bladder cancer or any otherform ofcancer been associated with exposure to phenyl-beta-naphthylamine? M.D., Peoria, Illinois Phenyl-beta-naphthylamine is manufac tured in this country by BASF Wyandotte Company. In the past it had been used in the manufacture of rubber tires. Accord ing to the company only 10 lbs. was used in the U.S. last year. There are a number of chemicals used in rubber manufacture, notably benzene, and occupationally exposed workers in the rubber industry have been reported to have excess rates of bladder cancer and leukemia. But it is not possible to attribute any of the higher risk to use of phenylbeta-naphthylamine. Lawrence Garfinkel Assistant Vice President for Epidemiology and Statistics American Cancer Society New York, New York My patient is a 21-year-old auto mechan ic with theproved diagnosis ofHodgkin's disease, stage III/B of mixed cellularity, discovered in May of 1977. He was com pletely staged and retroperitoneal nodes were negative, as was the spleen. During thefirst cycle ofMOPP chemotherapy he developed an unquestionable allergy''to procarbazine, and a small re-challenge brought back the anaphylactoid reaction. / was thenforcedto use theABVD regimen ofDr. Bonnadonna. After three cycles of ABVD, he received irradiation of up to 3000 rads to the bulky sites, according to the suggestion ofDr. Leonard R. Prosnifz (Ca 26:2826, 1976). Soon he will complete his sixth and last cycle ofABVD. Most reports state that ABVD is com parable to MOPP; one exception is a short abstract that appeared in the Proceedings ofthe Society ofHematology meeting hold in San Diego , last December. This report prompts me to askyou two questions: 1) Do you give much credence to this recent assertion that AB VD is not as ef fective as MOPP? 2) Ifyou agree with this report, would you recommend that this man (stage III/B ofmixed cellularity) befoliowed by a total nodal irradiation in the usual manner, as suggested by the Stanfordgroup? M.D., San Clemente, California R0 01 09<+A CA-A CANCER JOURNAL FOR CLINICIANS The MOPP program remains the standard and most proven chemotherapy regimen for the treatment of Hodgkin's disease, There are a number of other combinations benefit from adjuvant chemotherapy if total nodal radiation is given. If, ujfact, the patient had pathologic Stage III/B disease then radiation therapy is an in- which have been reported to produce com- adequate treatment program and chemo- plete response rates comparable to those therapy should be the primary approach. ofMOPP, but none has shown the quality If, as has been described, there has been or duration of the MOPP response, at an allergy to procarbazine one can sub least as reported by DeVita and confirmed stitute for procarbazine in the MOPP at Stanford. regimen, utilizing a nitrosurea or adria- The MOPP program can produce 80% myarin. As stated, the ABVD regimen complete response, on the average, for all may be equivalent, but would not be the patients treated; two-thirds of the com- first choice in a primary treatment pro- plete responders remain free of disease at gram. There are experimental and chemo- fiveand 10 years on an actuarial basis. therapy for Stage III/B disease but the The ABVD program of Dr. Bonna- role of radiation therapy has not yet been donna has been compared to the MOPP regimen; the ABVD treatment is a combination modality in which radiation is also given. To date these two approaches, established. If the patient has pathologic Stage II/B disease and has received 3,000 rads to known sites of disease as well as 6 cycles of ABVD, this can be considered a show equivalent results. However, there very acceptable treatment program since, are not enough data in the literature to in this case, the ABVD will be givenas an demonstrate how ABVD, used alone as a .- adjuvant and the radiotherapy is the ma primary treatment, compares with MOPP. jor form of disease control. With regard to the patient with clinical Stage III/B, but pathological Stage II/B Hodgkin's disease of mixed cellularity Saul A. Rosenberg. M.D. type, the following comments can be professor of Medicine and Radiology made: Chief, Division of Oncology The Stanford study shows that patients Stanford University Medical Center with pathologic Stage II/B disease do not Stanford, California VOL. 28, NO. 2 MARCH/APRIL 1978 ROfil -I'-'h ?