Oral etoposide and cyclophosphamide: A low-cost palliative metronomic chemotherapy in advanced pediatric cancers

Abstract

Introduction: Oral metronomic chemotherapy (OMC) is a less intensive and cost-effective palliative treatment modality in children with relapsed/refractory cancers in low-middle income countries. We aimed to study the safety and efficacy of OMC with oral etoposide and cyclophosphamide in relapsed/refractory pediatric malignancies treated at our center.Patients and Methods: This was a retrospective study from the case records of patients treated at our center from 2011 to 2018. Patients <18 years old and who received at least one cycle of OMC were included in the study. Cyclophosphamide and etoposide were given at a dose of 25 mg or 50 mg daily. Schedule of the drugs was variable; the most common schedule followed was 2 weeks on, followed by 2 weeks off. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method.Results: A total of 49 patients were included in the study. The median age was 8 years (range, 1–18 years) and 23/49 (46%) were males. The most common malignancies were Ewing's sarcoma (n = 13, 26%) and neuroblastoma (n = 11, 22%). The median duration of OMC intake was 50 days (range, 9–570 days). The clinical benefit rate was 22.4% with 10.2% patients having partial response and 12.2% having stable disease. Thirty-two (65.3%) patients had progressive disease on OMC and six (12.2%) were lost to follow-up. The median PFS was 63 days (95% confidence interval [CI], 18–107 days) and median OS was 155 days (95% CI, 19–219 days). Lower age and longer duration of treatment were independent predictors of higher OS.Conclusion: Oral cyclophosphamide and etoposide are a convenient and economical regimen with response rates and survival similar to those historically reported from other OMC regimes.