1
|
Gebbia V, Martorana F, Scandurra G, Valerio MR, Cufari S, Vigneri P, Sanò MV, Scollo P. A retrospective, real-life analysis of metronomic oral single-agent cyclophosphamide for the treatment of platinum-pretreated advanced ovarian carcinoma in Italy. J Oncol Pharm Pract 2023:10781552231189867. [PMID: 37501558 DOI: 10.1177/10781552231189867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Metronomic oral cyclophosphamide (MOC) presents many potential advantages, such as significantly less severe side effects than standard regimens, ease of administration, and the delivery of a dose-dense but not necessarily dose-intense treatment. These observations prompted us to evaluate in a retrospective, multicenter study the efficacy and toxicity of MOC in a real-life series of pretreated cancer patients. METHODS The study is a multicenter, retrospective analysis of the activity of single-agent MOC in patients with recurrent or residual epithelial ovarian, fallopian tube, or primary. Eligible patients were continuously treated with MOC at 50 mg/day until progression, toxicity, or death. Overall response rate (ORR), stable disease (SD), and disease control rate (DCR) were reported. RESULTS The study included 62 patients. Three patients reached a complete response rate (5%), 11 had a partial response rate (18), and 15 had stabilization of disease (24) for an ORR of 23% and a DCR of 47%. Patients with low-grade indolent tumors showed an ORR and an SD rate higher than that observed in non-indolent ones (33% vs. 18% and 28% vs. 14%, respectively). Overall, progression-free survival was 3.5 months (range 1-9 months). CONCLUSION Single-agent MOC is active and very well tolerated in a significant fraction of patients with refractory, recurrent, or residual epithelial ovarian, fallopian tube, or primary peritoneal cancer. In the vision of a practical approach, single-agent MOC may be a useful palliative treatment option for patients with poor tolerance to high-dose regimens or widely pretreated. Further studies are needed better to characterize the role of such an approach in clinical practice.
Collapse
Affiliation(s)
- Vittorio Gebbia
- Casa di Cura Torina, Palermo, Italy
- Faculty of Medicine and Surgery, Kore University, Enna, Italy
| | - Federica Martorana
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | | | | | | | - Paolo Vigneri
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
| | - Paolo Scollo
- Faculty of Medicine and Surgery, Kore University, Enna, Italy
- Gynecological Oncology Unit, Ospedale Cannizzaro, Catania, Italy
| |
Collapse
|
2
|
Hall MR, Dehbi HM, Banerjee S, Lord R, Clamp A, Ledermann JA, Nicum S, Lilleywhite R, Bowen R, Michael A, Feeney A, Glasspool R, Hackshaw A, Rustin G. A phase II randomised, placebo-controlled trial of low dose (metronomic) cyclophosphamide and nintedanib (BIBF1120) in advanced ovarian, fallopian tube or primary peritoneal cancer. Gynecol Oncol 2020; 159:692-698. [PMID: 33077258 DOI: 10.1016/j.ygyno.2020.09.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND We investigated the safety and efficacy of a combination of the oral tyrosine kinase inhibitor, nintedanib (BIBF 1120) with oral cyclophosphamide in patients with relapsed ovarian cancer. PATIENTS AND METHODS Patients with relapsed ovarian, fallopian tube or primary peritoneal cancer received oral cyclophosphamide (100 mg o.d.) and were randomised (1,1) to also have either oral nintedanib or placebo. The primary endpoint was overall survival (OS). Secondary endpoints included progression free survival (PFS), response rate, toxicity, and quality of life. RESULTS 117 patients were randomised, 3 did not start trial treatment, median age 64 years. Forty-five (39%) had received ≥5 lines chemotherapy. 30% had received prior bevacizumab. The median OS was 6.8 (nintedanib) versus 6.4 (placebo) months (hazard ratio 1.08; 95% confidence interval 0.72-1.62; P = 0.72). The 6-month PFS rate was 29.6% versus 22.8% (P = 0.57). Grade 3/4 adverse events occurred in 64% (nintedanib) versus 54% (placebo) of patients (P = 0.28); the most frequent G3/4 toxicities were lymphopenia (18.6% nintedanib versus 16.4% placebo), diarrhoea (13.6% versus 0%), neutropenia (11.9% versus 0%), fatigue (10.2% versus 9.1%), and vomiting (10.2% versus 7.3%). Patients who had received prior bevacizumab treatment had 52 days less time on treatment (P < 0.01). 26 patients (23%) took oral cyclophosphamide for ≥6 months. There were no differences in quality of life between treatment arms. CONCLUSIONS This is the largest reported cohort of patients with relapsed ovarian cancer treated with oral cyclophosphamide. Nintedanib did not improve outcomes when added to oral cyclophosphamide. Although not significant, more patients than expected remained on treatment for ≥6 months. This may reflect a higher proportion of patients with more indolent disease or the higher dose of cyclophosphamide used. CLINICAL TRIAL REGISTRATION Clinicaltrials.govNCT01610869.
Collapse
Affiliation(s)
- M R Hall
- Mount Vernon Cancer Centre, Northwood, UK.
| | - H-M Dehbi
- Comprehensive Clinical Trials Unit at UCL, London, UK.
| | - S Banerjee
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
| | - R Lord
- Clatterbridge Cancer Centre, Liverpool, UK.
| | - A Clamp
- The Christie NHS Foundation Trust and University of Manchester, UK.
| | - J A Ledermann
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.
| | - S Nicum
- Churchill Hospital, Oxford, UK.
| | - R Lilleywhite
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.
| | - R Bowen
- Royal United Hospital, Bath, UK.
| | - A Michael
- Royal Surrey County Hospital, Guildford, UK.
| | - A Feeney
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.
| | | | - A Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.
| | - G Rustin
- Mount Vernon Cancer Centre, Northwood, UK.
| |
Collapse
|
3
|
Gupta R, Cristea M, Frankel P, Ruel C, Chen C, Wang Y, Morgan R, Leong L, Chow W, Koczywas M, Koehler S, Lim D, Luu T, Martel C, McNamara M, Somlo G, Twardowski P, Yen Y, Idorenyi A, Raechelle T, Carroll M, Chung V. Randomized trial of oral cyclophosphamide versus oral cyclophosphamide with celecoxib for recurrent epithelial ovarian, fallopian tube, and primary peritoneal cancer. Cancer Treat Res Commun 2019; 21:100155. [PMID: 31279962 PMCID: PMC9018111 DOI: 10.1016/j.ctarc.2019.100155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 04/26/2023]
Abstract
BACKGROUND Oral metronomic chemotherapy, which has low toxicity, has demonstrated promising anti-tumor and anti-angiogenic properties that may lead to prolonged progression-free survival and improved response rates in patients with recurrent epithelial ovarian cancer (EOC). These effects may be enhanced by the co-administration of anti-angiogenic agents. METHODS We conducted a randomized phase II clinical trial to evaluate the therapeutic benefit of oral metronomic cyclophosphamide (CTX) alone and with the anti-angiogenic drug celecoxib in patients with gynecological malignancies. 52 patients were randomly assigned to two treatments arms: 50 mg oral CTX daily alone (Arm A) or with 400 mg celecoxib twice daily (Arm B). The primary endpoint was response rate. Secondary endpoints included toxicity, time to treatment failure, and overall survival. RESULTS In Arm A (n = 26), 3 patients (12%) had stable disease >6 months and 1 (4%) had a partial response. In Arm B, 5 (19%) had stable disease >6 months and 1 patient (4%) had a partial response. There were no significant between-group differences in overall survival (9.69 months [95% CI 3.84-13.18] vs. 12.55 months [6.67-17.61]) or in median time to treatment failure (1.84 months [1.68-2.76] vs. 1.92 months [1.64-5.22]). The most common adverse events were nausea, vomiting, and abdominal pain. CONCLUSIONS Oral metronomic CTX has activity with no major toxicities in heavily pretreated recurrent gynecological cancers and may be considered in patients with indolent disease. We did not observe any additional benefit of celecoxib treatment, though this may be due to small sample sizes.
Collapse
Affiliation(s)
- Rohan Gupta
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Mihaela Cristea
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Paul Frankel
- Information Sciences, City of Hope National Cancer Center, Duarte, CA, United States
| | - Christopher Ruel
- Information Sciences, City of Hope National Cancer Center, Duarte, CA, United States
| | - Chen Chen
- Clinical Informatics, City of Hope National Cancer Center, Duarte, CA, United States
| | - Yingyu Wang
- Clinical Informatics, City of Hope National Cancer Center, Duarte, CA, United States
| | - Robert Morgan
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Lucille Leong
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Warren Chow
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Marianna Koczywas
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Steve Koehler
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Dean Lim
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Thehang Luu
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Cynthia Martel
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Mark McNamara
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - George Somlo
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Przemyslaw Twardowski
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Yun Yen
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Amanam Idorenyi
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States
| | - Tinsley Raechelle
- Clinical Trial Office, City of Hope National Cancer Center, Duarte, CA, United States
| | - Mary Carroll
- Clinical Trial Office, City of Hope National Cancer Center, Duarte, CA, United States
| | - Vincent Chung
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, CA, United States.
| |
Collapse
|
4
|
Baruah U, Barmon D, Hazarika M, Deka P, Kataki AC, Shrivastava S. Continuous low-dose oral chemotherapy in recurrent and persistent carcinoma of cervix following chemoradiation: a comparative study between prolonged oral cyclophosphamide and oral Etoposide. Indian J Palliat Care 2014; 20:208-11. [PMID: 25191008 PMCID: PMC4154168 DOI: 10.4103/0973-1075.138396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim: To compare the efficacy and toxicities of low-dose oral cyclophosphamide and oral etoposide in patients with persistent and recurrent cervical cancer with gross pelvic disease following full course of chemoradiation therapy. Materials and Methods: 30 patients with recurrent and persistent cervical cancer with gross pelvic disease were enrolled in this trial. The patients were randomly divided into two groups of 15 patients each with one group receiving low dose oral cyclophosphamide (100 mg/day) and the other group receiving low-dose oral etoposide (50 mg/day). Results were statistically analysed by IBM SPSS Statistics 19. Results: Oral etoposide was not well tolerated with grade 2 neutropenia occurring in 33.3% and grade 3 neutropenia in 6.6% and thrombocytopenia occurring in 13.3%. Oral cyclophosphamide group on the other hand was better tolerated with none of the patients having thrombocytopenia and 6.6% patients having grade 2 neutropenia. There were two complete response (15.38%) and one partial response at the end of study (7.6%) in the cyclophosphamide group whereas there was no complete response and two partial response (16.6%) in the oral etoposide group. Conclusion: Long-term, low-dose oral etoposide was found to be less tolerated without any significant effect with patients with persistent and recurrent cervical cancer with gross pelvic disease following full course of chemoradiation therapy in contrast to oral cyclophosphamide which was found to be effective and well-tolerated by the patients.
Collapse
Affiliation(s)
- Upasana Baruah
- Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Debabrata Barmon
- Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Munlima Hazarika
- Department of Medical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Pankaj Deka
- Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Amal Chandra Kataki
- Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Sushruta Shrivastava
- Department of Gynaecologic Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| |
Collapse
|