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Asowed M, Elander NO, Pettersson L, Ekholm M, Papantoniou D. Activity and safety of KEES - an oral multi-drug chemo-hormonal metronomic combination regimen in metastatic castration-resistant prostate cancer. BMC Cancer 2023; 23:309. [PMID: 37016322 PMCID: PMC10074662 DOI: 10.1186/s12885-023-10780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Metastatic castration-resistant prostate cancer (mCRPC) remains a therapeutic challenge and evidence for late-line treatments in real-life is limited. The present study investigates the efficacy and safety of an oral metronomic chemo-hormonal regimen including cyclophosphamide, etoposide, estramustine, ketoconazole and prednisolone (KEES) administered in a consecutive biweekly schedule. METHODS A retrospective cohort study in two Swedish regions was conducted. Overall (OS) and progression-free survival (PFS), biochemical response rate (bRR) and toxicities were analyzed. RESULTS One hundred and twenty-three patients treated with KEES after initial treatment with at least a taxane or an androgen-receptor targeting agents (ARTA) were identified. Of those, 95 (77%) had received both agents and were the primary analysis population. Median (95% CI) OS and PFS in the pre-treated population were 12.3 (10.1-15.0) and 4.4 (3.8-5.5) months, respectively. Biochemical response, defined as ≥ 50% prostate-specific antigen (PSA) reduction, occurred in 26 patients (29%), and any PSA reduction in 59 (65%). PFS was independent of prior treatments used, and KEES seemed to be effective in late treatment lines. The bRR was higher compared to historical data of metronomic treatments in docetaxel and ARTA pre-treated populations. In multivariable analyses, performance status (PS) ≥ 2 and increasing alkaline phosphatase (ALP) predicted for worse OS. Nausea, fatigue, thromboembolic events and bone marrow suppression were the predominant toxicities. CONCLUSIONS KEES demonstrated meaningful efficacy in heavily pre-treated CRPC patients, especially those with PS 0-1 and lower baseline ALP, and had an acceptable toxicity profile.
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Affiliation(s)
- Mustafa Asowed
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Nils O Elander
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Linn Pettersson
- Department of Oncology, Ryhov County Hospital, Jönköping, 551 85, Sweden
| | - Maria Ekholm
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 83, Sweden
- Department of Oncology, Ryhov County Hospital, Jönköping, 551 85, Sweden
| | - Dimitrios Papantoniou
- Department of Oncology, Ryhov County Hospital, Jönköping, 551 85, Sweden.
- Department of Medical Sciences, Endocrine Oncology, Uppsala University, Uppsala, 751 85, Sweden.
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Metronomic Chemotherapy in Prostate Cancer. J Clin Med 2022; 11:jcm11102853. [PMID: 35628979 PMCID: PMC9143236 DOI: 10.3390/jcm11102853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
Despite the significant expansion of the therapeutic armamentarium associated with the introduction of novel endocrine therapies, cytotoxic agents, radiopharmaceuticals, and PARP inhibitors, progression of metastatic castration-resistant prostate cancer (mCRPC) beyond treatment options remains the leading cause of death in advanced prostate cancer patients. Metronomic chemotherapy (MC) is an old concept of wise utilization of cytotoxic agents administered continuously and at low doses. The metronomic is unique due to its multidimensional mechanisms of action involving: (i) inhibition of cancer cell proliferation, (ii) inhibition of angiogenesis, (iii) mitigation of tumor-related immunosuppression, (iv) impairment of cancer stem cell functions, and (v) modulation of tumor and host microbiome. MC has been extensively studied in advanced prostate cancer before the advent of novel therapies, and its actual activity in contemporary, heavily pretreated mCRPC patients is unknown. We have conducted a prospective analysis of consecutive cases of mCRPC patients who failed all available standard therapies to find the optimal MC regimen for phase II studies. The metronomic combination of weekly paclitaxel 60 mg/m2 i.v. with capecitabine 1500 mg/d p.o. and cyclophosphamide 50 mg/d p.o. was selected as the preferred regimen for a planned phase II study in heavily pretreated mCRPC patients.
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Parshad S, Sidhu AK, Khan N, Naoum A, Emmenegger U. Metronomic Chemotherapy for Advanced Prostate Cancer: A Literature Review. J Clin Med 2022; 11:jcm11102783. [PMID: 35628909 PMCID: PMC9147851 DOI: 10.3390/jcm11102783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 12/10/2022] Open
Abstract
Metastatic castration-resistant prostate cancer (mCRPC) is the ultimately lethal form of prostate cancer. Docetaxel chemotherapy was the first life-prolonging treatment for mCRPC; however, the standard maximally tolerated dose (MTD) docetaxel regimen is often not considered for patients with mCRPC who are older and/or frail due to its toxicity. Low-dose metronomic chemotherapy (LDMC) is the frequent administration of typically oral and off-patent chemotherapeutics at low doses, which is associated with a superior safety profile and higher tolerability than MTD chemotherapy. We conducted a systematic literature review using the PUBMED, EMBASE, and MEDLINE electronic databases to identify clinical studies that examined the impact of LDMC on patients with advanced prostate cancer. The search identified 30 reports that retrospectively or prospectively investigated LDMC, 29 of which focused on mCRPC. Cyclophosphamide was the most commonly used agent integrated into 27/30 (90%) of LDMC regimens. LDMC resulted in a clinical benefit rate of 56.8 ± 24.5% across all studies. Overall, there were only a few non-hematological grade 3 or 4 adverse events reported. As such, LDMC is a well-tolerated treatment option for patients with mCRPC, including those who are older and frail. Furthermore, LDMC is considered more affordable than conventional mCRPC therapies. However, prospective phase III trials are needed to further characterize the efficacy and safety of LDMC in mCRPC before its use in practice.
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Affiliation(s)
- Shruti Parshad
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (S.P.); (A.K.S.); (N.K.); (A.N.)
- Biological Sciences Research Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Amanjot K. Sidhu
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (S.P.); (A.K.S.); (N.K.); (A.N.)
- Biological Sciences Research Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Nabeeha Khan
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (S.P.); (A.K.S.); (N.K.); (A.N.)
- Biological Sciences Research Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Andrew Naoum
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (S.P.); (A.K.S.); (N.K.); (A.N.)
- Biological Sciences Research Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (S.P.); (A.K.S.); (N.K.); (A.N.)
- Biological Sciences Research Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A1, Canada
- Correspondence: ; Tel.: +1-416-480-4928; Fax: +1-416-480-6002
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Fedele P, Sanna V, Fancellu A, Marino A, Calvani N, Cinieri S. De-escalating cancer treatments during COVID 19 pandemic: Is metronomic chemotherapy a reasonable option? Crit Rev Oncol Hematol 2020; 157:103148. [PMID: 33254036 PMCID: PMC7672334 DOI: 10.1016/j.critrevonc.2020.103148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023] Open
Abstract
COVID 19 pandemic represents an emergency for public health services. The reorganization of the healthcare system has had an important impact on the management of cancer patients. Oral treatments and de-escalation strategies are encouraged. Oral metronomic chemotherapy could be a reasonable treatment option in some cancer patients subgroups during COVID 19 pandemic.
COVID 19 pandemic represents an emergency for public health services and containment measures to reduce the risk of infection have been promptly activated worldwide. The healthcare systems reorganization has had a major impact on the management of cancer patients who are considered at high risk of infection. Recommendations and guidelines on how to manage cancer patients during COVID 19 pandemic have been published. Oral administration of chemotherapy is recommended to limit the access of cancer patients to hospital facilities and in some cases to guarantee the continuum of care. Low-dose metronomic administration of chemotherapy with different drugs and schedules has emerged in the last years as a possible alternative to conventional chemotherapy, due to its promising tumor control rates and excellent safety profiles. Moreover, given that many metronomic schedules use the oral route administration, it could represent a therapeutic strategy to ensure continuum of cancer care during COVID 19 pandemic. In this review we have selected all the clinical studies that have used the metronomic strategy, especially with oral drugs, in order to identify the subgroups of cancer patients who can benefit most from a metronomic approach even during COVID 19 pandemic.
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Affiliation(s)
- Palma Fedele
- Medical Oncology, Dario Camberlingo Hospital, Francavilla Fontana (Br), Italy.
| | - Valeria Sanna
- Medical Oncology, Hospital of Sassari, Sassari, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery, University of Sassari, Sassari, Italy
| | - Antonella Marino
- Medical Oncology & Breast Unit, Antonio Perrino Hospital, Brindisi, Italy
| | - Nicola Calvani
- Medical Oncology & Breast Unit, Antonio Perrino Hospital, Brindisi, Italy
| | - Saverio Cinieri
- Medical Oncology & Breast Unit, Antonio Perrino Hospital, Brindisi, Italy
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Calvani N, Morelli F, Naglieri E, Gnoni A, Chiuri VE, Orlando L, Fedele P, Cinieri S. Metronomic chemotherapy with cyclophosphamide plus low dose of corticosteroids in advanced castration-resistant prostate cancer across the era of taxanes and new hormonal drugs. Med Oncol 2019; 36:80. [DOI: 10.1007/s12032-019-1304-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
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Caffo O, Facchini G, Biasco E, Ferraù F, Morelli F, Donini M, Buttigliero C, Calvani N, Guida A, Chiuri VE, Basso U, Mucciarini C, Conteduca V, Rossetti S, Veccia A, Maines F, Kinspergher S, De Giorgi U. Activity and safety of metronomic cyclophosphamide in the modern era of metastatic castration-resistant prostate cancer. Future Oncol 2019; 15:1115-1123. [DOI: 10.2217/fon-2018-0715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aim: To evaluate activity of metronomic cyclophosphamide (mCTX) in heavily pretreated metastatic castration-resistant prostate cancer (mCRPC) patients. Patients & methods: We retrospectively evaluated a consecutive series of 74 mCRPC patients treated with at least one new agent after docetaxel failure, who received once-daily oral mCTX treatment at a fixed dose of 50 mg. Results: The treatment was well tolerated. Sixteen percent of the patients experienced a major biochemical response. Median progression-free survival was 4.0 months, and median overall survival was 8.1 months. Conclusions: In the modern context of mCRPC, mCTX may represent a valuable and inexpensive alternative to new agents, which have shown similar activity in heavily pretreated patients.
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Affiliation(s)
- Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Gaetano Facchini
- Departmental Unit of Clinical & Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale, Via Mariano Semmola 52, 80131 Naples, Italy
| | - Elisa Biasco
- Oncology Unit 2, University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Francesco Ferraù
- Medical Oncology Department, San Vincenzo Hospital, Via Sirina, 98039 Taormina, Italy
| | - Franco Morelli
- Medical Oncology Department, Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy
| | - Maddalena Donini
- Medical Oncology Department, General Hospital, Viale Concordia, 26100 Cremona, Italy
| | - Consuelo Buttigliero
- Medical Oncology Department, University of Torino, San Luigi Hospital, Regione Gonzole 10, 10043 Orbassano, Italy
| | - Nicola Calvani
- Medical Oncology Division & Breast Unit, Antonio Perrino Hospital, 72100 Brindisi, Italy
| | - Annalisa Guida
- Medical Oncology Division, Azienda Ospedaliero Universitaria, Policlinico di Modena, 41100 Modena, Italy
| | | | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV, IRCCS, 35128 Padua, Italy
| | | | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - Sabrina Rossetti
- Departmental Unit of Clinical & Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G Pascale, Via Mariano Semmola 52, 80131 Naples, Italy
| | - Antonello Veccia
- Medical Oncology Department, Santa Chiara Hospital, Largo Medaglie d'Oro, 38122 Trento, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Largo Medaglie d'Oro, 38122 Trento, Italy
| | - Stefania Kinspergher
- Medical Oncology Department, Santa Chiara Hospital, Largo Medaglie d'Oro, 38122 Trento, Italy
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
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Ling HH, Lin YC. Metronomic Oral Cyclophosphamide in 2 Heavily Pretreated Patients With Metastatic Castration-resistant Prostate Cancer With Homologous Recombination Deficiency (HRD): A Case Report. Clin Genitourin Cancer 2019; 17:157-160. [PMID: 30630673 DOI: 10.1016/j.clgc.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Hang Huong Ling
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung Branch, Taiwan
| | - Yung-Chang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan Branch, Taiwan; School of Medicine, Chang Gung University, Taoyuan City, Taiwan.
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Simsek C, Esin E, Yalcin S. Metronomic Chemotherapy: A Systematic Review of the Literature and Clinical Experience. JOURNAL OF ONCOLOGY 2019; 2019:5483791. [PMID: 31015835 PMCID: PMC6446118 DOI: 10.1155/2019/5483791] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 12/24/2018] [Accepted: 02/05/2019] [Indexed: 02/07/2023]
Abstract
Metronomic chemotherapy, continuous and dose-dense administration of chemotherapeutic drugs with lowered doses, is being evaluated for substituting, augmenting, or appending conventional maximum tolerated dose regimens, with preclinical and clinical studies for the past few decades. To date, the principle mechanisms of its action include impeding tumoral angiogenesis and modulation of hosts' immune system, affecting directly tumor cells, their progenitors, and neighboring stromal cells. Its better toxicity profile, lower cost, and easier use are main advantages over conventional therapies. The evidence of metronomic chemotherapy for personalized medicine is growing, starting with unfit elderly patients and also for palliative treatment. The literature reviewed in this article mainly demonstrates that metronomic chemotherapy is advantageous for selected patients and for certain types of malignancies, which make it a promising therapeutic approach for filling in the gaps. More clinical studies are needed to establish a solidified role for metronomic chemotherapy with other treatment models in modern cancer management.
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Affiliation(s)
- Cem Simsek
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ece Esin
- Department of Medical Oncology, A.Y. Ankara Training Hospital, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University, Ankara, Turkey
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[Metronomic chemotherapy with oral cyclophosphamide : An individual option for the metastatic castration-resistant prostate cancer patient?]. Urologe A 2018; 58:410-417. [PMID: 29808369 DOI: 10.1007/s00120-018-0679-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multiple experimental approaches are meanwhile available for progressive metastatic castration resistant prostate cancer (mCRPC) patients after failure of guideline recommended therapy (i. e., chemotherapy and/or hormonal treatment). We evaluated the outcome of metronomic chemotherapy with cyclophosphamide (CY) in combination with low-dose prednisolone. MATERIALS AND METHODS A total of 14 mCRPC-patients were treated with CY 50 mg/day (plus prednisolone 10 mg/day) between November 2012 and September 2017 after being resistant or unfit for chemotherapy and/or further hormonal treatment. Time to progression and overall survival (OS) were retrospectively determined by using Kaplan-Meier curves. RESULTS Eight of 14 (57.1%) patients had undergone radical prostatectomy and 2 (14.3%) external beam radiation. All patients had at least three therapy lines and 50% had ≥5 mCRPC therapies. The median time from first diagnosis to mCRPC was 88 months; the median age was 78 years with a median baseline serum prostate-specific antigen (PSA) level of 341 ng/ml. With a median follow-up of 16.4 months, progression-free survival (PFS) was 71, 64, and 43% after 2, 4, and 6 months, respectively. Median OS was 8.1 months. No relevant adverse events occurred. CONCLUSION Since CY is a well-tolerated medication with partially good clinical tumor control, it seems to be a convenient, individual treatment option in progressive mCRPC patients after failure of guideline recommended therapy.
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Jeong Y, Lee JL. Efficacy of metronomic oral cyclophosphamide with low dose dexamethasone and celecoxib in metastatic castration-resistant prostate cancer. Asia Pac J Clin Oncol 2016; 13:204-211. [DOI: 10.1111/ajco.12583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Yumun Jeong
- Department of Medicine; Asan Medical Centre, University of Ulsan College of Medicine; Seoul South Korea
| | - Jae Lyun Lee
- Department of Medicine; Asan Medical Centre, University of Ulsan College of Medicine; Seoul South Korea
- Department of Oncology; Asan Medical Centre; University of Ulsan College of Medicine; Seoul South Korea
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11
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Metronomic cyclophosphamide therapy in hormone-naive patients with non-metastatic biochemical recurrent prostate cancer: a phase II trial. Med Oncol 2016; 33:89. [DOI: 10.1007/s12032-016-0806-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
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Caubet M, Dobi E, Pozet A, Almotlak H, Montcuquet P, Maurina T, Mouillet G, N'guyen T, Stein U, Thiery-Vuillemin A, Fiteni F. Carboplatin-etoposide combination chemotherapy in metastatic castration-resistant prostate cancer: A retrospective study. Mol Clin Oncol 2015; 3:1208-1212. [PMID: 26807222 PMCID: PMC4665308 DOI: 10.3892/mco.2015.628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/22/2015] [Indexed: 11/26/2022] Open
Abstract
The combination of cisplatin or carboplatin and etoposide is the standard treatment for certain poorly differentiated neuroendocrine cancers, such as small-cell lung cancer. The aim of this study was to assess the efficacy and tolerability of the carboplatin-etoposide regimen in metastatic castration-resistant prostate cancer (mCRPC). A total of 27 patients treated by carboplatin [area under the curve (AUC)=5] and etoposide (100 mg/m2 intravenous infusion on days 1–3 or 75 mg orally/day for 10 days) for mCRPC were included for analysis. The median progression-free survival was 3.3 months [95% confidence interval (CI): 1.9–4.2] and the median overall survival (OS) was 8.1 months (95% CI: 4.06–12.36). The main grade 3–4 toxicities were haematological, namely anemia (33.3%), neutropenia (25.9%) and thrombocytopenia (22.2%), whereas the most common non-hematological toxicity was asthenia (22.2%). The efficacy, compliance and safety profile were generally similar between the oral and intravenous etoposide groups. Pretreated patients with mCRPC may benefit from the carboplatin-etoposide regimen in terms of OS. The toxicities were acceptable, without reported treatment-related mortality. Therefore, the oral etoposide regimen may be an viable alternative for improving the quality of life of the patients. However, this regimen requires further prospective investigation to confirm its efficacy.
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Affiliation(s)
- Matthieu Caubet
- Department of Radiotherapy, University Hospital of Besançon, 25030 Besançon, France
| | - Erion Dobi
- Department of Medical Oncology, University Hospital of Besançon, 25030 Besançon, France; Department of Medical Oncology, Hospital of Montbéliard, 25200 Montbéliard, France
| | - Astrid Pozet
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, 25030 Besançon, France
| | - Hamadi Almotlak
- Department of Medical Oncology, University Hospital of Besançon, 25030 Besançon, France; Department of Medical Oncology, Hospital of Lons-le-Saunier, 39000 Lons-le-Saunier, France
| | - Philippe Montcuquet
- Department of Medical Oncology, University Hospital of Besançon, 25030 Besançon, France; Department of Medical Oncology, Vesoul Hospital, 70000 Vesoul, France
| | - Tristan Maurina
- Department of Medical Oncology, University Hospital of Besançon, 25030 Besançon, France; Department of Medical Oncology, Hospital of Montbéliard, 25200 Montbéliard, France
| | - Guillaume Mouillet
- Department of Medical Oncology, University Hospital of Besançon, 25030 Besançon, France; Department of Medical Oncology, Hospital of Montbéliard, 25200 Montbéliard, France
| | - Thierry N'guyen
- Department of Medical Oncology, University Hospital of Besançon, 25030 Besançon, France
| | - Ulrich Stein
- Department of Medical Oncology, University Hospital of Besançon, 25030 Besançon, France; Department of Medical Oncology, Vesoul Hospital, 70000 Vesoul, France
| | | | - Frederic Fiteni
- Department of Medical Oncology, University Hospital of Besançon, 25030 Besançon, France; Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, 25030 Besançon, France
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