BACKGROUND: The number of elderly people with soft tissue sarcoma (STS) is increasing. A sizeable population of elderly patients with STS is unfit for conventional doxorubicin- or ifosfamide-based chemotherapy. We assessed the feasibility of metronomic oral cyclophosphamide (CPM) in this population. PATIENTS AND METHODS: Patients aged 65 years or older with unresectable STS received CPM 100mg twice daily plus prednisolone 20mg daily, the first week of a 2-week cycle in the outpatient setting. Main evaluation criterion was safety. Secondary evaluation criteria were objective response rate and progression-free survival. RESULTS: Twenty-six patients (median age: 72, range 66-88) received a total of 330 cycles (median per patient: 10, range 2-41) as first (n=19) or second-line chemotherapy (n=7). The most frequent histological subtypes were poorly differentiated sarcoma (n=8), leiomyosarcoma and liposarcoma (n = 5 each) and angiosarcoma (n=3). Grade ≥3 lymphopenia was observed in 81% of pts but no opportunist infection occurred. Grade 3 anaemia and thrombocytopenia occurred in 2 pts (8%) each. No other grade 3-4 toxicity was seen. The response rate was 26.9% (95%CI: 9.9-44.0) and the disease control rate (responses and stable disease >12 weeks) was 69.2% (95%CI: 51.5-87.0). One complete (hepatic epithelioid haemangio-endothelioma) and 6 partial responses (including 5pts with radiation-induced sarcomas) were seen. Progression-free survival ranged from 0 to 20.6 months (median: 6.8 months) and was significantly longer in patients with radiation-induced sarcomas (median: 7.8 versus 5.2 months, p=0.02). CONCLUSION: Metronomic CPM showed good safety results for this frail population, with promising activity in patients with radiation-induced sarcoma. Toxicity profile was favourable, allowing prolonged home staying and rare treatment discontinuations. A larger prospective study is warranted to confirm these encouraging results in elderly with STS.
BACKGROUND: The number of elderly people with soft tissue sarcoma (STS) is increasing. A sizeable population of elderly patients with STS is unfit for conventional doxorubicin- or ifosfamide-based chemotherapy. We assessed the feasibility of metronomic oral cyclophosphamide (CPM) in this population. PATIENTS AND METHODS: Patients aged 65 years or older with unresectable STS received CPM 100mg twice daily plus prednisolone 20mg daily, the first week of a 2-week cycle in the outpatient setting. Main evaluation criterion was safety. Secondary evaluation criteria were objective response rate and progression-free survival. RESULTS: Twenty-six patients (median age: 72, range 66-88) received a total of 330 cycles (median per patient: 10, range 2-41) as first (n=19) or second-line chemotherapy (n=7). The most frequent histological subtypes were poorly differentiated sarcoma (n=8), leiomyosarcoma and liposarcoma (n = 5 each) and angiosarcoma (n=3). Grade ≥3 lymphopenia was observed in 81% of pts but no opportunist infection occurred. Grade 3 anaemia and thrombocytopenia occurred in 2 pts (8%) each. No other grade 3-4 toxicity was seen. The response rate was 26.9% (95%CI: 9.9-44.0) and the disease control rate (responses and stable disease >12 weeks) was 69.2% (95%CI: 51.5-87.0). One complete (hepatic epithelioid haemangio-endothelioma) and 6 partial responses (including 5pts with radiation-induced sarcomas) were seen. Progression-free survival ranged from 0 to 20.6 months (median: 6.8 months) and was significantly longer in patients with radiation-induced sarcomas (median: 7.8 versus 5.2 months, p=0.02). CONCLUSION: Metronomic CPM showed good safety results for this frail population, with promising activity in patients with radiation-induced sarcoma. Toxicity profile was favourable, allowing prolonged home staying and rare treatment discontinuations. A larger prospective study is warranted to confirm these encouraging results in elderly with STS.
Authors: Eugenie Younger; Saskia Litière; Axel Le Cesne; Olivier Mir; Hans Gelderblom; Antoine Italiano; Sandrine Marreaud; Robin Lewis Jones; Alessandro Gronchi; Winette T A van der Graaf Journal: Oncologist Date: 2018-04-12
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Authors: Shiwen Peng; Sofia Lyford-Pike; Belinda Akpeng; Annie Wu; Chien-Fu Hung; Drew Hannaman; John R Saunders; T-C Wu; Sara I Pai Journal: Cancer Immunol Immunother Date: 2012-08-04 Impact factor: 6.968
Authors: R L Jones; G D Demetri; S M Schuetze; M Milhem; A Elias; B A Van Tine; J Hamm; S McCarthy; G Wang; T Parekh; R Knoblauch; M L Hensley; R G Maki; S Patel; M von Mehren Journal: Ann Oncol Date: 2018-09-01 Impact factor: 32.976
Authors: Evangelos Briasoulis; Gerasimos Aravantinos; George Kouvatseas; Periklis Pappas; Eirini Biziota; Ioannis Sainis; Thomas Makatsoris; Ioannis Varthalitis; Ioannis Xanthakis; Antonios Vassias; George Klouvas; Ioannis Boukovinas; George Fountzilas; Kostantinos N Syrigos; Haralambos Kalofonos; Epaminontas Samantas Journal: BMC Cancer Date: 2013-05-29 Impact factor: 4.430