Metronomic oral cyclophosphamide (MOC) therapy in the recurrent and advanced ovarian cancer patients: a retrospective study

Introduction: To evaluate the efficacy of cycled oral cyclophosphamide therapy in recurrent and advanced ovarian cancer patients. Materials and Method: Recurrent and advanced ovarian cancer patients who are unfit for intensive chemotherapy were prescribed oral cyclophosphamide at the dose of 50 mg twice daily for 10 days, cycled every 28 days. Treatment-related toxicity was[N1] assessed by National cancer institute – common terminology criteria for adverse events(NCI-CTCAE) and response to treatment were assessed by Response evaluation criteria in solid tumours (RECIST) and clinical assessment. Progression-free (PFS), and overall survival (OS) were assessed using Kaplan meier survival analysis. Results: 71 patients of ovarian cancer admitted to our centre from January 2012 to March 2015 with mean age of 61.2±0.74 years were analyzed: 44 patients (61.9%) were platinum refractory/resistant, while 26 patients (36.6%) were platinum sensitive; 60 patients (84%) had received atleast one previous chemotherapy before starting MOC. The objective response rate (ORR) (complete and partial response) was 20%. Stable disease was seen in 22 patients (30.9%) and 17patients had response duration ≥6 months, 8 patients had continued response for more than 1 year. Progression during treatment was observed in 49 patients (69.01%). Median PFS was 5 months (range 2 – 25 months), and the 12-month PFS was 11%; and the 12-month OS was 26% Median PFS for patients who responded to MOC was 9 months whereas 2 months for those who progressed (p = 0.01). Median OS of responding patients was 14 months whereas it was 8 months for patients progressive on MOC (p = 0.02). No significant toxicity was observed. Conclusions: MOC is an effective therapy in the treatment of recurrent and advanced ovarian cancer patients, unfit for intensive chemotherapy.