title: Prolonged progression-free survival with maintenance metronomic oral cyclophosphamide and etoposide treatment in macroscopic residual disease or recurrent/advanced stage ovarian cancer.
abstract: OBJECTIVE
  In ovarian cancer permanent remission may be provided with optimal cytoreductive surgery and adjuvant chemotherapy. However survival is short in patients with residual macroscopic disease after surgery or recurrent ovarian cancer. Applicable maintenance therapies with low toxicity are required to prolong progression-free survival (PFS) for patients with no curative treatment options. In this study, we investigated the effect of maintenance metronomic oral cyclophosphamide and etoposide (CE) in ovarian cancer patients with post operative residual or recurrent disease.
  
  
  METHODS
  Forty five patients that received metronomic oral CE (cyclophosphamide 50 mg/daily and etoposide 50 mg for 1-5 days, every 21 days) as maintenance therapy for residual disease due to incomplete surgical resection or recurrent advanced-stage ovarian cancer were evaluated. The time between the beginning of oral CE and disease progression was also evaluated.
  
  
  RESULTS
  The mean patient age was 58 years, the vast majority had serous adenocarcinoma (78%) and received a mean of 2 (range 1-4) lines of various intravenous regimens for postoperative residual or recurrent disease. Mean duration of oral CE was 11.3 months (range 2.9-29). Median PFS was 10.3 months (range 7.9-12.8). Only 5 patients discontinued treatment due to intolerance and grade 3-4 toxicity was recorded in 3 patients (7%).
  
  
  CONCLUSIONS
  Maintenance metronomic oral CE treatment was found effective, minimally toxic and sustainable in patients with macroscopic residual or recurrent advanced-stage ovarian cancer. However, randomized and placebo-controlled well designed studies are required.
authors.affiliation: Afyon Kocatepe University Faculty of Medicine, Department of Medical Oncology, Afyon, Turkey.
authors.forename: Mukremin
authors.initials: M
authors.lastname: Uysal
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozdogan
authors.forename: Aysegul
authors.initials: A
authors.lastname: Kargi
authors.forename: Seyda
authors.initials: S
authors.lastname: Gunduz
authors.forename: Sema
authors.initials: S
authors.lastname: Sezgin Goksu
authors.forename: Ali
authors.initials: A
authors.lastname: Murat Tatli
authors.forename: Deniz
authors.initials: D
authors.lastname: Arslan
authors.forename: Hasan
authors.initials: H
authors.lastname: Mutlu
authors.forename: Hasan
authors.initials: H
authors.lastname: Senol Coskun
authors.forename: Hakan
authors.initials: H
authors.lastname: Bozcuk
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005047:Etoposide / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D060046:Maintenance Chemotherapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000188:drug therapy*
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide