A phase II study of oral metronomic combination therapy in relapsed epithelial ovarian cancer.

Gupta, Sudeep; Goyal, Gautam; Ghosh, Jaya; Bhosale, Bharat; Bajpai, Jyoti; Maheshwari, Amita; Kerkar, Rajendra; Deodhar, Kedar; Rekhi, Bharat; Menon, Santosh; Banavali, Shripad

doi:10.1200/jco.2013.31.15_suppl.5554

Cited by 4 publications

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“…[26] While many lines of intravenous chemotherapy have been effective in relapsed ovarian cancer, a recent Phase II study reports on the use of oral metronomic combination therapy. [27] Twenty-six patients of relapsed EOC were accrued, of whom 21 had received two prior lines of CT and five had received three lines. Twenty-five patients who were evaluable for analysis received a median of 6 (1-19) cycles of metronomic regimen -etoposide (50 mg/m 2 ) and cyclophosphamide (50 mg/m 2 ) for 21 of a 28-day cycle plus tamoxifen (20 mg/m 2 , twice per day) continuously.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Gynecological cancers: A summary of published Indian data

Maheshwari

Kumar

Mahantshetty

2016

South Asian J Cancer

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Gynecological cancers are among the most common cancers in women and hence an important public health issue. Due to the lack of cancer awareness, variable pathology, and dearth of proper screening facilities in developing countries such as India, most women report at advanced stages, adversely affecting the prognosis and clinical outcomes. Ovarian cancer has emerged as one of the most common malignancies affecting women in India and has shown an increase in the incidence rates over the years. Although cervical cancer is on a declining trend, it remains the second most common cancer in women after breast cancer. Many researchers in India have published important data in the field of gynecologic oncology, covering all domains such as basic sciences, preventive oncology, pathology, radiological imaging, and clinical outcomes. This work has given us an insight into the in-depth understanding of these cancers as well as the demographics and survival rates in the Indian population. This aim of this review is to discuss the important studies done in India for all gynecological cancers.

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Section: Clinical Outcomesmentioning

confidence: 99%

Gynecological cancers: A summary of published Indian data

Maheshwari

Kumar

Mahantshetty

2016

South Asian J Cancer

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“…[ 9 10 11 ] Among studies in ovarian carcinoma, majority of studies using metronomic therapy have used in either relapsed/refractory ovarian carcinoma or in combination with standard chemotherapy to improve outcomes due to antiangiogenic effect with minimal toxicity. [ 11 12 13 14 ] As the cost of metronomic therapy is <16$/month compared to a single cycle of standard paclitaxel carbopaltin doublet (300$) with demonstrated benefit, we started the use of metronomic oral chemotherapy first in relapsed/refractory ovarian carcinoma followed by maintenance therapy after definitive treatment and finally as neoadjuvant therapy in nonaffording patients with poor tolerance to standard platin doublet.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of advanced epithelial ovarian cancer with integration of metronomic chemotherapy: An Indian rural cancer centre experience

Pandey

Abhay²,

Jandyal

et al. 2016

South Asian J Cancer

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Background:Paclitaxel-platinum and optimal cytoreductive surgery are the standard of care for ovarian carcinoma. Poor socioeconomic profile and therapeutic constraints in rural India poses a therapeutic challenge.Aim:To evaluate outcomes of epithelial ovarian carcinoma.Objectives:To calculate disease-free survival (DFS), overall survival (OS), and factors affecting outcomes.Materials and Methods:Data of patients diagnosed as ovarian carcinoma registered between March 2009 and March 2014 were retrieved. Demographic profile, chemotherapy and response, surgery, and disease progression were collected. Patients who underwent surgery or completed three cycles of chemotherapy were selected. Kaplan–Meir survival was used to determine disease-free and OS. Log-rank test used to evaluate factors affecting outcome.Results:Median follow-up is 26 months. 93/102 patients (91%) underwent cytoreductive surgery, of which 37 had primary cytoreduction (40%) while 56 had interval cytoreduction. 21/93 (23%), 57/93 (61%), and 15/93 (16%) patients were operated by local surgeons, surgeons of our hospital, and trained oncosurgeons, respectively. Induction paclitaxel-platinum was used in 35/63 (56%) patients while 28/63 patients (44%) received neoadjuvant metronomic chemotherapy. Median DFS and OS are 17 and 54 months respectively while 3 year OS of 66%. Median DFS of patients operated by oncosurgeons versus local surgeons were 22 months versus 15 months (P = 0.01), OS was 54 versus 26 months (P = 0.01).40/88 (45%) patients received maintenance metronomic therapy after adjuvant chemotherapy with median of 6 months (range 2–18 months). Patients receiving metronomic maintenance had better DFS, 18 months versus 15 months (P = 0.69).Conclusion:Induction therapy in ovarian carcinoma helps in selecting patients for cytoreductive surgery. Outcomes are better if operated by trained oncosurgeons. Maintenance metronomic has potential to delay disease progression.

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“…We used cyclophosphamide at a similar dose in patients with ovarian cancer in an earlier phase II study performed at our institution. 21 Clinical, radiologic, and serologic responses were assessed every 12 weeks. Dose reduction was done for grade 3 or 4 toxicities.…”

Section: Context Key Objectivementioning

confidence: 99%

Pazopanib and Oral Cyclophosphamide in Women With Platinum-Resistant or -Refractory Epithelial Ovarian Cancer

Gulia

Ghosh

Bajpai

et al. 2020

JCO Global Oncology

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PURPOSE Women with recurrent, multiply-treated epithelial ovarian cancer (EOC) have unfavorable prognosis with limited treatment options after failure of platinum-based regimens. We report here a retrospective analysis of women with recurrent, platinum-resistant EOC treated with an oral regimen of pazopanib and cyclophosphamide. PATIENTS AND METHODS Women with recurrent platinum-resistant or -refractory EOC were treated with pazopanib (600 mg orally daily in 2 divided doses, 400 and 200 mg) and cyclophosphamide (50 mg orally daily for 21 days every 28 days) until disease progression or unacceptable toxicity. RESULTS Twenty patients (17 with platinum-resistant and 3 with platinum-refractory disease) were treated between April 2014 and April 2018. Patients had a median age of 52 years (range, 40-60 years) and median of 4 previous lines of chemotherapy (range, 2-8 previous lines), including 3 patients with progressive disease on bevacizumab. Patients received a median of 6 cycles (range, 2-48 cycles) of pazopanib and cyclophosphamide, with best responses of partial response in 9 patients (45%, including 1 of 3 patients treated previously with bevacizumab), stable disease in 6 patients (30%), and disease progression in 5 patients (25%). The median progression-free survival time was 5.5 months, and median overall survival was 9.5 months. Common adverse events (grade 3 or 4) were fatigue (25%), diarrhea (15%), hand-foot syndrome (10%), mucositis (10%), transaminitis (5%), and hypertension (5%). Dose reduction as a result of toxicity was required in 14 patients (70%), and no patient stopped treatment as a result of toxicity. CONCLUSION Pazopanib plus oral cyclophosphamide is a well-tolerated regimen with clinically relevant benefit in patients with platinum-resistant or -refractory EOC.

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A phase II study of oral metronomic combination therapy in relapsed epithelial ovarian cancer.

Cited by 4 publications

References 0 publications

Gynecological cancers: A summary of published Indian data

Gynecological cancers: A summary of published Indian data

Outcomes of advanced epithelial ovarian cancer with integration of metronomic chemotherapy: An Indian rural cancer centre experience

Pazopanib and Oral Cyclophosphamide in Women With Platinum-Resistant or -Refractory Epithelial Ovarian Cancer

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