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Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 64-68

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

Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

Correspondence Address:
Venkatraman Radhakrishnan
Department of Medicalc Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_90_19

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Introduction: Oral metronomic chemotherapy (OMC) is a less intensive and cost-effective palliative treatment modality in children with relapsed/refractory cancers in low-middle income countries. We aimed to study the safety and efficacy of OMC with oral etoposide and cyclophosphamide in relapsed/refractory pediatric malignancies treated at our center. Patients and Methods: This was a retrospective study from the case records of patients treated at our center 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. Results: A total of 49 patients were included in the study. 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. Conclusion: Oral cyclophosphamide and etoposide are a convenient and economical regimen with response rates and survival similar to those historically reported from other OMC regimes.

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