Evaluation of the Clinical Response and tolerance of Low dose metronomic Chemotherapy and Quality of Life assessment in advanced Carcinoma Ovary, Breast and Lymphomas

Arun Philip, (2013) Evaluation of the Clinical Response and tolerance of Low dose metronomic Chemotherapy and Quality of Life assessment in advanced Carcinoma Ovary, Breast and Lymphomas. Masters thesis, Cancer Institute (WIA), Chennai.


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BACKGROUND: Metronomic chemotherapy (MCT) refers to the regular administration of a chemotherapeutic agent at non Toxic low doses, over prolonged periods, with short or no drug-free periods. In comparison to the conventional Maximum Tolerated Dose (MTD) schedules, the MCT schedules have shown reduced acute toxicities such as high grade myelosuppression, vomiting, nausea, mucositis and frequently, surprisingly good anti-tumor activity has been observed even when used in drug resistant tumors. Indian Data on metronomic chemotherapy in any malignancy is very limited. This study was done with the aim of exploring the scope of such a metronomic schedule in three very common malignancies that we come across in clinical practice; Carcinoma Breast, Carcinoma Ovary and Lymphomas, with a special emphasis on the Response Rates, Toxicities and the Quality of Life. MATERIALS AND METHODS: The study was a single centre, non randomised, prospective study done on patients of Carcinoma Ovary, Carcinoma Breast and Lymphomas (Both Non Hodgkin and Hodgkin Lymphomas), who had progressive disease on therapy or recurrence and were not considered for Intravenous chemotherapy. All the cases were treated at Adyar Cancer Institute, Chennai between May 2011and November 2012. The MCT schedule in Carcinoma Breast and Ovary consisted of Oral Etoposide and Cyclophosphamide in a 3 week on, 1 week off schedule given till progression. In Lymphomas, it was a continuous daily schedule of Oral Etoposide, Cyclophosphamide and Prednisolone. RESULTS: A total of 75 patients [35 cases of Carcinoma Breast, 18 cases of Carcinoma Ovary, 22 case of Lymphomas were enrolled into the study. The Overall clinical benefit rate in Carcinoma Breast was 48%, the Overall Response Rate in Carcinoma Ovary was 10% and the Overall Response rate in Lymphomas was 37%. The schedule was tolerated well with few Grade 3 / 4 toxicities. The Quality of Life (QOL) data showed Improved QOL scores in the 2nd and 4th months of therapy in Carcinoma Breast and Lymphomas and in tallying with the response rates, the QOL score among Ovarian Carcinoma patients showed a worsening trend in the 2nd and 4th months of therapy. CONCLUSIONS: We found that the novel metronomic schedule of Oral Etoposide and Cyclophosphamide is a reasonable option in relapsed or metastatic Breast Cancer patients, with good Clinical Benefit. Although the response rates to metronomic schedule in patients with Ovarian Carcinoma was low, the progression free survival at 1 year was comparable with most other studies. In Lymphomas, the results of the metronomic chemotherapy schedule have been encouraging. Mantle cell Lymphoma was one histological subtype where the response was significantly better. The Metronomic schedule was well tolerated by all the three groups of patients in the study, with hardly any Grade 3 / 4 toxicities. The QOL analysis, among Carcinoma Breast and Lymphoma patients revealed better QOL scores in the 2nd and 4th months of the metronomic schedule indicative of the good response to therapy. The Ovarian cancer Subset seems to have had lower QOL scores at 2 and 4 months into treatment. This novel metronomic chemotherapy schedule seems to be a good option in recurrent Breast and Ovarian Cancer and Lymphomas. Although the sample size of the study is small and the follow up short, this could serve as a benchmark for future studies.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical Response, tolerance of Low dose metronomic Chemotherapy, Quality of Life assessment, advanced Carcinoma Ovary, Breast and Lymphomas.
Subjects: MEDICAL > Medical Oncology
Depositing User: Subramani R
Date Deposited: 29 Feb 2020 02:06
Last Modified: 29 Feb 2020 02:06
URI: http://repository-tnmgrmu.ac.in/id/eprint/12050

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