title: Metronomic therapy for refractory/relapsed lymphoma: the PEP-C low-dose oral combination chemotherapy regimen.
abstract: BACKGROUND
  Metronomic therapy is the application of continuous, low dose chemotherapy. The doses of chemotherapy are usually not sufficient to destroy neoplastic cells, but impact the milieu, particularly angiogenesis.
  
  
  OBJECTIVE
  To determine if the oral PEP-C regimen, consisting of prednisone 20 mgm, etoposide 50 mgm, procarbazine 50 mgm, and cyclophosphamide 50 mgm given in either a daily, alternate day, or fractionated basis, is effective in a variety of lymphomas.
  
  
  METHODS
  One hundred twenty two patients were studied although the majority had low grade or mantle cell lymphoma. All had received at least two or more prior therapies.
  
  
  RESULTS
  Overall, 75% achieved an objective response (OR) with 38% complete responses (CRs) or CRs unconfirmed, and 37% partial responses. ORs were achieved in mantle cell (85%), follicular (88%), marginal zone (71%), and small lymphocytic (67%) lymphomas. Chemosensitive disease was more responsive. Toxicity was minimal.
  
  
  CONCLUSIONS
  The PEP-C regimen is an easily administered highly effective treatment for heavily pretreated mantle cell and low grade lymphomas.
authors.affiliation: Center for Lymphoma and Myeloma, Weill Cornell Medical College, The New York-Presbyterian Hospital, New York, NY, USA. mortoncolemanmd@aol.com
authors.forename: Morton
authors.initials: M
authors.lastname: Coleman
authors.forename: Gia
authors.initials: G
authors.lastname: Ruan
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Elstrom
authors.forename: Peter
authors.initials: P
authors.lastname: Martin
authors.forename: John P
authors.initials: JP
authors.lastname: Leonard
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D042783:Endothelial Cells / Q000187:drug effects / Q000276:immunology; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use*; D015972:Gene Expression Regulation, Neoplastic / Q000187:drug effects; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D011344:Procarbazine / Q000008:administration & dosage / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000235:genetics; D055502:Secondary Prevention; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D000970:Antineoplastic Agents; D042461:Vascular Endothelial Growth Factor A; D011344:Procarbazine; D005047:Etoposide; D003520:Cyclophosphamide; D040262:Receptors, Vascular Endothelial Growth Factor; D011241:Prednisone