Oral metronomic cyclophosphamide in elderly with metastatic melanoma.

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Invest New Drugs. 2009 Aug 12.

Oral metronomic cyclophosphamide in elderly with metastatic melanoma.
Borne E, Desmedt E, Duhamel A, Mirabel X, Dziwniel V, Maire C, Florin V, Martinot V, Penel N, Vercambre-Darras S, Mortier L.
Clinique de Dermatologie, Centre Hospitalier Régional et Universitaire, Université Lille 2, Lille, France.
 
Introduction
In Western countries, the number of frail elderly people with
metastatic melanoma (MM) keeps increasing. Conventional chemotherapy
frequently induces imbalance in frail physiological cases. We propose
to treat these patients with oral metronomic cyclophosphamide. Patients
and methods This retrospective study analyses the data of patients with
unresectable MM who received 50 to 100 mg of cyclophosphamide a day, 3
weeks out of 4. Main evaluation criterion was safety. Secondary
evaluation criteria were objective response rate and overall survival.
Results Thirteen patients were included (median age: 80, 5 AJCC stage
III and 8 AJCC stage IV). Clinical and biological safety were good,
leading to long home staying and rare treatment discontinuations. Main
toxicity observed was lymphopenia; no opportunist infection occurred.
The control rate was 46%: one partial response and five stable diseases
(median: 10 months). Survival after beginning of treatment ranged from
4 to 37 months (median: 8 months). Discussion Literature about MM in
frail elderly is limited. Still, specific treatment is necessary.
Cyclophosphamide in metronomic schema was well tolerated. The response
rate was difficult to assess (small population) but several patients
presented with long lasting stabilisation. The mechanisms of action of
this treatment are original, associating antiangiogenic action and
immunomodulation. Conclusion Cyclophosphamide in metronomic schema
showed good safety results for this frail population. Oral treatment
enabled patients to stay at home longer and limited hospitalisation
time. A larger controlled study will be necessary to confirm these
encouraging results in elderly with MM, a classical chemoresistant
tumor.