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An Overview of the GND Chemotherapy Regimen

written by: ellaalle • edited by: Diana Cooper • updated: 1/29/2011

The GND chemotherapy regimen (or GVD) is a chemical treatment for later-stage Hodgkin's lymphoma. Learn about this treatment, including information on administration, side effects and more.

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    Introduction

    The GND chemotherapy regimen is used for classical Hodgkin's lymphoma. The GND treatment is used when patients have a transplant failure or do not respond to primary chemotherapy. The respective trade names are Gemzar, Navelbine and Doxil. It is closely related to GVD therapy, which replaces the trade name Navelbine with its generic name, vinorelbine ditartrate. GND chemotherapy has a similar efficacy but lower toxicity than other salvage treatments.

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    Pharmacology

    Gemcitabine is the generic name for Gemzar. Doxil is the brand name of pegylated liposomal doxorubicin hydrochloride.

    Gemcitabine is a standard tumor-destroying agent and is cytotoxic, or cell-destroying. It harbors many of the side effects of chemotherapy, such as nausea and hair loss. This chemical entity replaces DNA and RNA in the cell division process, disallowing cell growth. The body recognizes the gemcitabine as foreign, and the cell cannot multiply. Like both Navelbine and Doxil, gemcitabine does not recognize the difference between healthy and tumor cells. Gemcitabine also competitively inhibits ribonucleotide reductase, which is required for cell division.

    Navelbine prevents cell division by inhibiting a necessary process called mitosis. The end result is potential cancer destruction and other somatic cell destruction. Navelbine is derived from Catharanthus roseus, and may be administered orally. For better bioavailability, it is administered in clinical and research practice via the IV route.

    Doxil is an extended-release version of doxorubicin. The liposomal form allows the drug to stay within the bloodstream and attack the tumor over time. It is also a cytotoxic agent. Doxorubicin has a bacterial origin, and is relatively expensive to semi-synthetically products. It is hypothesized to work by breaking the base pair between DNA.

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    Administration

    All products are administered intravenously. Two doses are given one week apart.

    In ongoing clinical trials, the GND administration is dosed as follows:

    Transplant naive:

    G 1000 mg/meter squared over 6-10 minutes

    V 20 mg/m squared over 30 minutes and

    D 15 mg/m squared over 90 minutes

    Transplanted patients:

    G 800 mg/m(2),

    V 15 mg/m(2), and

    D 10 mg/m(2)

    Transplant refers to stem cell transplantation. This study used GND chemotherapy in conjunction with a monoclonal antibody called SGN-30.

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    Side effects

    Clinical trials and use of GND chemotherapy are small, but most patients report lesser side effects than traditional chemotherapy. Since the GND protocol is often a late stage treatment, data sets can be smaller. Clinical reports indicate nausea, vomiting, hair loss and fatigue. The regimen can cause changes in biochemical markers, such as decrease in white blood cell count.

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    Efficacy

    The overall response rate for the GND chemotherapy regimen is 70%. In addition, 19% of the subjects went into complete remission. The treatment is generally well-tolerated, but patients can have a predisposition to side effects based on their genetic makeup.

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    References

    N. Bartlett, D. Niedzwiecki, J. Johnson, J. Friedberg, K. Johnson, K. Van Besien, A. Zelenetz, B. Cheson, and G. Canellos. "Gemcitabine, Vinorelbine, and Pegylated Liposomal Doxorubicin (GVD), a Salvage Regimen in Relapsed Hodgkin's Lymphoma: CALGB 59804." Annals of Oncology 18.6 (2007): 1071-079. Print.

    "Definition of Pegylated Liposomal Doxorubicin Hydrochloride - National Cancer Institute Drug Dictionary." Comprehensive Cancer Information - National Cancer Institute. Web. 21 Jan 2011. http://www.cancer.gov/drugdictionary/?CdrID=39424.

    "Gemcitabine." American Cancer Society :: Information and Resources for Cancer: Breast, Colon, Prostate, Lung and Other Forms. Web. 21 Jan 2011. http://www.cancer.org/Treatment/TreatmentsandSideEffects/GuidetoCancerDrugs/GEMCITABINE.

    "Gemzar®, Navelbine®, and Doxil®: A Promising Regimen for Relapsed Hodgkin Lymphoma." Cancer Consultants Oncology Home Page. Web. 21 Jan 2011. http://professional.cancerconsultants.com/oncology_hodgkins_news.aspx?id=29386.

    "Navelbine (Vinorelbine Tartrate) Drug Information: User Reviews, Side Effects, Drug Interactions and Dosage at RxList." Web. 21 Jan 2011. http://www.rxlist.com/navelbine-drug.htm.

    "SGN-30 and Combination Chemotherapy in Treating Patients With Relapsed or Refractory Hodgkin's Lymphoma - Full Text View - ClinicalTrials.gov." Home - ClinicalTrials.gov. Web. 21 Jan 2011. <http://clinicaltrials.gov/ct2/show/NCT00337194?term=gvd&rank=1>.



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