Maintenance Metronomic Chemotherapy in Treatment of Metastatic Colorectal Cancer

Y. V. Baranau,О. V. Streltsova,А. S. Portyanko,Е. I. Suboch,А. V. Prokharau

doi:10.5539/cco.v8n1p35

Abstract

Treatment of metastatic colorectal cancer (mCRC) is one of the most challenging and important problems in oncology at present moment. This article presents the interim results of treatment of patients with colorectal cancer, who were enrolled from 2016 till 2019 (n=60) with the use of maintenance metronomic chemotherapy. Metronomic regimen consisted of oral capecitabine 500 mg 3 times a day and oral cyclophosphane 50 mg daily. The control arm consisted of mCRC patients who received the same induction chemotherapy without maintenance from 2011 till 2015 (n=70). Median follow-up time was 18.5 months. Median progression-free survival (PFS) was 9.0 and 7.4 months in the maintenance and control arms respectively. Median overall survival (OS), counted from the beginning of induction chemotherapy, is currently 22.9 months in the maintenance arm, and 14.7 months in control. High expression levels of genes, encoding enzymes TS (thymidylate synthetase), DPD (dihydropyrimidine dehydrogenase) and receptor VEGFR1, low expression level of gene TP (thymidylate phosphorylase), as well as low levels of tumor markers CEA and СА 19-9 are the prognostic factors of sensitivity to metronomic chemotherapy given to colorectal cancer patients. Based on these data, we identified a group of patients who are recommended to use this method of treatment.

Highlights

Colorectal cancer is on the third place among oncological diseases for its frequency both in the Republic of Belarus and in the whole world and is one of the main causes of cancer deaths
The present study aims to evaluate the role of metronomic regimen including low doses of capecitabine and cyclophosphane in maintenance treatment of metastatic colorectal cancer (mCRC) patients who have received the first-line induction chemotherapy
Tumor progression was registered in 48 patients, the time from the start of induction chemotherapy to disease progression varied from 5.8 to 20.6 months

Summary

Introduction

Colorectal cancer is on the third place among oncological diseases for its frequency both in the Republic of Belarus and in the whole world and is one of the main causes of cancer deaths. Five-year survival of patients with distant metastases not eligible for surgical treatment is less than 5% (Ferlay, Steliarova-Foucher & Lortet-Tieulent, 2012; Okeanov, Moiseyev & Levin, 2014). The improvement of efficacy of colorectal cancer treatment is one of the urgent problems of modern oncology because of incidence rate growth, high metastasis frequency and low survival rates. Chemotherapy plays a major role in treatment of patients with mCRC. It has made significant progress during the last years: with modern chemotherapy regimens life expectancy exceeds 20 months. One of the probable treatment strategies is so called maintenance treatment, which means that after the completion of standard induction therapy, a patient continues to take less toxic drugs until tumor progression (Chibaudel et al, 2012)

Objectives

Methods

Results

Discussion

Conclusion