title: Weekly Multi-agent Chemotherapy (CMF-b) for Advanced Non-melanoma Skin Cancer.
abstract: OBJECTIVE
  Advanced unresectable and metastatic non-melanoma skin cancers (NMSC) are rare, but often arise in elderly patients. When surgery or irradiation are no longer feasible, chemotherapy is often precluded by the patient's age and comorbidities. Whether low-dose multi-agent chemotherapy could be an alternative for this vulnerable population in an outpatient setting was the issue examined in this retrospective analysis.
  
  
  METHODS
  Twenty-six patients with advanced unresectable or metastatic NMSC received weekly multi-agent chemotherapy with carboplatin at an area under the curve of 2 or 40 mg total dose of cisplatin, with 15 IU total dose of bleomycin, 40 mg total dose of methotrexate, and 500 mg total dose of 5-fluorouracil (CMF-b) until best response, toxicity, or progression of their disease.
  
  
  RESULTS
  Twenty-four patients were treated as outpatients; two were hospitalized. Twenty-three patients were previously treated with surgery or radiotherapy. The median age was 68 years (range=44-100 years). The median number of cycles was 6 (range=1 to 17). The overall response rate was 61.5% (seven complete remissions, nine partial remissions) for the entire cohort and 63.6% (two complete remissions and five partial remissions) for patients >80 years. The median duration of response was 6.1 months (range=1.6-63 months). Responses longer than 6 months were obtained in 11/26 (42.3%) of the entire cohort and in 4/11 (36.3%) patients >80 years. Symptom improvement was observed in 17 patients (65.3%). Toxicity was acceptable, with grade 3 renal failure (n=1) and grade 3 or 4 myelotoxicity (n=2).
  
  
  CONCLUSIONS
  CMF-b is a safe, weekly low-dose multi-agent regimen that offers palliation for vulnerable patients with NMSC.
authors.affiliation: Centre of Oncology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland vittoria.espeli@eoc.ch pierre-yves.dietrich@hcuge.ch.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Espeli
authors.affiliation: Plastic and Reconstructive Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Ruegg
authors.affiliation: Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Hottinger
authors.affiliation: Plastic and Reconstructive Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: Modarressi
authors.affiliation: Centre of Oncology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland vittoria.espeli@eoc.ch pierre-yves.dietrich@hcuge.ch.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Dietrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D001855:Bone Marrow Diseases / Q000139:chemically induced; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000556:secondary / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000556:secondary / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D012074:Remission Induction; D051437:Renal Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies; D016879:Salvage Therapy; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy
chemical_list: D001761:Bleomycin; D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate
keywords: Advanced non-melanoma skin cancer; chemotherapy; elderly