title: Low-dose metronomic, multidrug therapy with the PEP-C oral combination chemotherapy regimen for mantle cell lymphoma.
abstract: The prednisone, etoposide, procarbazine and cyclophosphamide (PEP-C) oral combination chemotherapy regimen (prednisone 20 mg, cyclophosphamide 50 mg, etoposide 50 mg, and procarbazine 50 mg with an oral anti-emetic) was employed at our center to treat 22 patients with heavily pretreated, recurrent mantle cell lymphoma (MCL). All medications were administered daily until leukocytes fell to <3.0 x 10(9)/L whereupon treatment was withheld until recovery from the nadir. Therapy was then reinstituted on a daily, alternate day, or fractionated basis (e.g. 5 of 7 days) depending on patient tolerance. Doses given per day were held constant. Eighty-two percent achieved an objective response with 46% complete responses and 36% partial responses. Median time on therapy was 17 months. The regimen was well tolerated. Our findings demonstrate that low-dose oral agents administered in combination for continuous, prolonged periods with minimal drug-free intervals (metronomic therapy) may represent a novel, effective, easily tolerated approach to MCL and that this treatment approach warrants further exploration.
authors.affiliation: Division of Hematology - Oncology, Department of Medicine, Center for Lymphoma and Myeloma, Weill Cornell Medical College, and New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Morton
authors.initials: M
authors.lastname: Coleman
authors.forename: Peter
authors.initials: P
authors.lastname: Martin
authors.forename: Jia
authors.initials: J
authors.lastname: Ruan
authors.forename: Richard
authors.initials: R
authors.lastname: Furman
authors.forename: Ruben
authors.initials: R
authors.lastname: Niesvizky
authors.forename: Rebecca
authors.initials: R
authors.lastname: Elstrom
authors.forename: Patricia
authors.initials: P
authors.lastname: George
authors.forename: John
authors.initials: J
authors.lastname: Leonard
authors.forename: Thomas
authors.initials: T
authors.lastname: Kaufmann
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000633:toxicity; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D007958:Leukocyte Count; D020522:Lymphoma, Mantle-Cell / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011344:Procarbazine; D005047:Etoposide; D003520:Cyclophosphamide; D011241:Prednisone