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Oral etoposide and cyclophosphamide: A low-cost palliative metronomic chemotherapy in advanced pediatric cancers

An article entiled "Oral etoposide and cyclophosphamide: A low-cost palliative metronomic chemotherapy in advanced pediatric cancers" has just been published in Cancer Research, Statistics, and Treatment by Kiran Kumar, Venkatraman Radhakrishnan, Manikandan Dhanushkodi, Jayachandran, Perumal Kalaiyarasi, Nikita Mehra, Arun Rajan Kumar, Gangothri Selvarajan, Trivadi S Ganesan, Tenali Gnana Sagar from the Department of Medical Oncology, Cancer Institute (WIA),Chennai, Tamil Nadu, India.

In this article, the authors report on their experience with total of 49 patients treated in their institution from from 2011 to 2018. Patients <18 years old and who received at least one cycle of OMC were included in the study. Cyclophosphamide and etoposide were given at a dose of 25 mg or 50 mg daily. Schedule of the drugs was variable; the most common schedule followed was 2 weeks on, followed by 2 weeks off. Progression‑free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method. The median age was 8 years (range, 1–18 years) and 23/49 (46%) were males. The most common malignancies were Ewing’s sarcoma (n = 13, 26%) and neuroblastoma (n = 11, 22%). The median duration of OMC intake was 50 days (range, 9–570 days). The clinical benefit rate was 22.4% with 10.2% patients having partial response and 12.2% having stable disease. Thirty‑two (65.3%) patients had progressive disease on OMC and six (12.2%) were lost to follow‑up. The median PFS was 63 days (95% confidence interval [CI], 18–107 days) and median OS was 155 days (95% CI, 19–219 days). Lower age and longer duration of treatment were independent predictors of higher OS. The authors conclude that oral cyclophosphamide and etoposide are a convenient and economical regimen with response rates and survival similar to those historically reported from other OMC regimen.

The article is in open acces and availabe freely to all. A pdf copy is associated with this post.