Breast cancer is the most common cancer in Pakistan. About two thirds of patients present in advanced stage of the disease. Multiple drug utilization is needed to prolong survival in these patients. Cheaper drugs are mainstay of treatment in recurrent disease in poor resource countries. We have investigated an oral drugs regimen in recurrent breast cancer patients.
A total of 116 female patients were included in the study. All patients had recurrent or persistent breast cancer (BC) and at least received chemotherapy (CT) with at least two different regimen. All patients were prescribed oral methotraxate (MTX) 2.5 mg twice in a week, oral cyclophosphamide 50 mg daily and capecitabine 500 mg twice a day for at least a period of three months. Response to therapy was assessed through clinical examination and computed tomography (CT) of the relevent site at three months from start of treatment. The primary endpoint was to assess progression free survival (PFS) and overall survival (OS).
98/116 (84%) of the patients were available for assessment of response to treatment protocol and hence to assess PFS and OS. Rest of the patients were excluded from the analysis due to inability to complete the treatment. 3 (3%) patients showed complete response, 43 (43.8%) of the patients showed partial response, 37 (37.7%) showed stable disease while 15 (15.3%) of the patients showed disease progression during treatment and were shifted to other treatment.Three year PFS and OS were 22% and 36% respectively. Mean and median PFS (year) were 1.08 Â± 0.09 (95% confidence interval [CI] 0.9 to 1.28) and 0.73 Â± 0.1 (95% CI 0.54 to 0.93) respectively. Mean and median OS (year) were 1.87 Â± 0.12 (95% CI 1.63 to 2.11) and 1.38 Â± 0.08 (95% CI 1.22 to 1.54) respectively.
Metronomic chemotherapy using capecitabine, methotrexate and cyclophophamide is valid option for recurrent or advanced breast cancer in resource poor patients.
Clinical trial identification
All authors have declared no conflicts of interest.