Abstract
Background: metronomic chemotherapy is based on antiangiogenic and immunologic mechanisms obtained by the administration of traditional cytotoxic drugs at lower concentration without rest periods. The low dosage induces fewer or no side effect compared to classic maximum tolerated dose administration (MTD). At present, no treatment related acute leukaemia was reported in cyclophosphamide-based metronomic chemotherapy (CMC). Case: We report the case of an 81-year-old man considered as having castration and chemo-refractory metastatic prostate cancer. CMC was started. Objective response was observed in this heavily pre-treated patient with progression free survival lasting more than 30 months. No toxicity was observed in this period and his autonomy was maintained. Finally, our patient developed a chemotherapy-induced acute myeloid leukaemia at 36th month of CMC. Conclusion: Even CMC is a well-tolerated treatment; secondary acute leukaemia is related to cumulative dose of cyclophosphamide. The benefit and the risk of long-term exposure to cyclophosphamide should be carefully balanced.
Highlights
Classic Maximum Tolerated Dose administration (MTD) is by definition the highest dose of a drug or treatment that does not cause unacceptable side effects
Case: We report the case of an 81-year-old man considered as having castration and chemo-refractory metastatic prostate cancer
We report here the first case of treatment related acute myeloid leukaemia secondary to long exposure to cyclophosphamide-based metronomic chemotherapy (CMC)
Summary
Classic Maximum Tolerated Dose administration (MTD) is by definition the highest dose of a drug or treatment that does not cause unacceptable side effects. Metronomic chemotherapy is the administration of traditional cytotoxic drugs at lower concentration without rest periods. The basis of this particular modality is supported by its antiangiogenic effect [2,3,4,5]. Cyclophosphamide-based metronomic chemotherapy (CMC) enhances immune response against tumour by inhibition of CD4+25+T regulatory cell function [6], whereas higher doses of cyclophosphamide are associated with cytotoxicity and immunosuppression [7,8]. No treatment related acute leukaemia was reported with CMC.
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