313P - Efficacy and safety of oral metronomic chemotherapy in recurrent refractory advanced gynaecological cancer: Experience from regional cancer center of eastern India

Background

Outcome of recurrent/metastatic gynaecological cancer has drastically improved with introduction of PARP inhibitors and immunotherapy; but use of these drugs in routine practice is very difficult due to access barrier and high cost in developing countries. We aimed to present response, treatment outcome and safety of oral metronomic chemotherapy (OMCT) in a financially challenged, resource limited population.

Methods

This is a retrospective study on patients with advanced gynaecological cancer treated at Chittaranjan National Cancer Institute, Kolkata-West Bengal from 2021-2023; with either split course tablet Cyclophosphamide (50 mg once daily orally for 21 days) and tablet Capecitabine (500 mg twice daily orally continuous) or fixed dose combination (1800 mg +80 mg orally for 14 days in every 21 days) till disease progression or unacceptable toxicities. All data captured from medical records of hospital up till June 2023. Toxicity data was reported as per CTCAE V5 and progression free survival (PFS) was estimated using Kaplan Meier methods.

Results

Among 32 screened patients; 9 excluded due to noncompliance. 24 patients were analysed with median age at diagnosis of 56 years (IQ range 44-75). 16 (67%) patients were stage IV diseases with ECOG performance status 3. Ovarian and cervical cancer were 80% and 20% respectively; among them 16 (67%) patients were platinum refractory. 42% patients received three prior lines of chemotherapy before OMCT. Spit course versus fixed dose were given 67% versus 33% of population with best response were CR in 12%, PR 67%, SD 21% as per RECIST v1.1. Most common toxicities were Grade I anaemia (54%), grade I CINV (46%), grade I fatigue (42%) and grade I neutropenia (21%). 25% of patients were offered next line systemic therapy after progression. Median PFS was 9 months (95% CI 5.2-12.7) of entire cohort. Cox regression analysis identified median PFS of 12 months (95% CI 6.2-17.7) among platinum refractory group.

Conclusions

This OMCT was well-tolerated, affordable regimen with durable clinical response and survival outcome in recurrent refractory advanced gynaecological cancer and can be offered among patients in resource limited centres.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.