1503P - Metronomic oral cyclophosphamide in the treatment of metastatic soft tissue sarcoma: is there a role for maintenance therapy?

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anti-Cancer Agents & Biologic Therapy
Soft Tissue Sarcomas
Presenter Anezca Ferrari
Authors A. Ferrari1, V.P. Camargo2, G.M. Bariani3, M.S. Goncalves2, P.M. Hoff2, G. De Castro Jr.4
  • 1Instituto do Cancer do Estado de Sao Paulo, 01246-000 - Sao Paulo/BR
  • 2Medical Oncology, Instituto do Cancer do Estado de Sao Paulo, 01246-000 - Sao Paulo/BR
  • 3Clinical Oncology, Instituto do Cancer do Estado de Sao Paulo, 01246-000 - Sao Paulo/BR
  • 4Oncologia Clínica, Instituto do Cancer do Estado de Sao Paulo, 01246-000 - Sao Paulo/BR

Abstract

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.

G.M. Bariani: Novartis: lecture fee, travel expenses covered. Roche: travel expenses covered.

All other authors have declared no conflicts of interest.