Hodgkin's Lymphoma

Hodgkin's lymphoma is an uncommmon lymphoma with a bimodal age distruction with the first peak between ages 15 and 35 and the second peak after 55 years or older. Older patients have difficulty tolerating the multi-agent chemothearpy. The same regimen ABVD has been used for 40 years as pioneered by Devita until Brentuximab-CHP was shown to be slightly more effective at curing patients with stage III or IV disease. Howeever, in that trial (ECHELON-1, Ansell, S. NEJM 2022;387:310-20), the overall 6 year survival in patients receiving standard ABVD was still 89.4% which is excellent.

This excellent 6 year outcome does not translate into patients treated in lower resource countries as the traditional understanding is that these drugs need to be shipped and stored between 2 and 8 degrees Celsius. Many countries either don't have refrigeration for shipping or in their pharmacy, or the cost of that refrigeration is not a priority when they have other patients and illnesses to treat. As a result, many international patients either do not get any chemotherapy treatment for this curable illness, or get intermittent treatment that may shrink, but not cure their disease.

There are approximately 8570 new cases of Hodgkin's lymphoma in the US each year (see here) and extrapolating that to the 7 billion patients world wide gives rise to an estimated 166,000 cases world-wide each year. Most cancer patients treated world-wide are treated through public cancer hospitals which struggle with the high costs of cancer care.

There is data (see here) suggesting that bleomycin can maintain most of its potency if stored out of direct sunlight for less than 4 weeks at room temperature. There is similar data for vinblastine (see here) and dacarbazine as well. (see here)