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Investigational New Drugs

, Volume 28, Issue 5, pp 684–689 | Cite as

Oral metronomic cyclophosphamide in elderly with metastatic melanoma

  • Estelle Borne
  • Eve Desmedt
  • Alain Duhamel
  • Xavier Mirabel
  • Véronique Dziwniel
  • Cyril Maire
  • Valérie Florin
  • Véronique Martinot
  • Nicolas Penel
  • Sophie Vercambre-Darras
  • Laurent MortierEmail author
PRECLINICAL STUDIES

Summary

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.

Keywords

Metastatic melanoma Frail elderly Cyclophosphamide Metronomic schedule 

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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Estelle Borne
    • 1
  • Eve Desmedt
    • 1
  • Alain Duhamel
    • 2
  • Xavier Mirabel
    • 3
  • Véronique Dziwniel
    • 4
  • Cyril Maire
    • 1
  • Valérie Florin
    • 1
  • Véronique Martinot
    • 5
  • Nicolas Penel
    • 6
  • Sophie Vercambre-Darras
    • 1
  • Laurent Mortier
    • 1
    • 7
    Email author
  1. 1.Clinique de Dermatologie, Centre Hospitalier Régional et UniversitaireUniversité Lille 2LilleFrance
  2. 2.Département de BiostatistiquesUniversité Lille 2LilleFrance
  3. 3.Département de RadiothérapieCentre Oscar LambretLilleFrance
  4. 4.Department of Modern LanguagesEcole Centrale de LilleVilleneuve d’AscqFrance
  5. 5.Département de Chirurgie PlastiqueCentre Hospitalier Régional et UniversitaireLilleFrance
  6. 6.Département de Cancérologie GénéraleCentre Oscar LambretLilleFrance
  7. 7.Clinique de DermatologieHôpital Claude HuriezLille cedexFrance

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