METRONOMIC ORAL CYCLOPHOSPHAMIDE IN THE TREATMENT OF METASTATIC SOFT TISSUE SARCOMA: IS THERE A ROLE FOR MAINTENANCE THERAPY?
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conferenceObject
Data de publicação
2012
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Editora
OXFORD UNIV PRESS
Citação
ANNALS OF ONCOLOGY, v.23, suppl.9, p.486-486, 2012
Resumo
Background Metronomic chemotherapy has been demonstrated to improve DFS in advanced STS. Here we aimed to analyze the efficacy and safety of metronomic oral cyclophosphamide (M-CTX) as maintenance or salvage therapy in these patients (pts). Methods It is a retrospective study of all advanced/metastatic STS pts (RMS, GIST, bone sarcomas excluded) treated in our institution between Feb/2009 and Jan/2012 with M-CTX 100 mg PO daily 21 out of 28 days, until disease progression (DP). Tumor response (RECIST 1.1) was assessed every 2 cycles. The primary endpoint of the study was time to treatment failure (TTF). Toxicity was graded according to the NCI-CTC v.3.0. criteria. Results 27 pts were consecutively included in this analysis. Thirteen pts received M-CTX as maintenance chemotherapy after presenting best response: median age 60 y, 9 female; 5 LMS, 3 HGUPS, 2 PNET, 3 others. Median number of previous chemotherapy regimens 2; 9 previously treated with doxorubicin and 4 with ifosfamide; 4 presented PR as best response. Median TTF (mTTF) was 9.2 mo, 4 pts (2 PNET, 1 LMS, 1 HGUPS) had mTTFs ≥ 6 mo and no deaths were observed in a median follow-up of 7 mo. 14 pts received M-CTX as salvage chemotherapy after DP: median age 45.5 y, 8 female; 3 LMS, 3 HGUPS, 3 synovial, 2 ASPS, 3 others. Median number of previous chemotherapy regimens 1.5; 11 previously treated with doxorubicin and 6 with ifosfamide; 1 PR as best response. mTTF 3.3 mo, 1 ASPS had mTTFs ≥ 6 mo, and 9 deaths (HR 1.403, 95%CI 0.608-3.236, p = 0.409, in comparison with maintenance strategy). In general, M-CTX was well tolerated, and the most common toxicity (>10%) included nausea G1 (5 pts), renal failure (3 pts), anemia G1 (4 pts), anemia G2 (3 pts), lymphopenia G1 (12 pts). Conclusions Metronomic oral cyclophosphamide seems to be a valid option as maintenance chemotherapy after presenting best response in advanced/metastatic STS, with acceptable toxicity. This compares favorably with historical controls (mPFS around 4 months). However, after disease progression, it is a futile chemotherapy regimen. Disclosure A.C.R. Ferrari: Travel expenses covered: Roche.