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Oral metronomic cyclophosphamide in elderly with metastatic melanoma

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Summary

Introduction In Western countries, the number of frail elderly people with metastatic melanoma (MM) keeps increasing. Conventional chemotherapy frequently induces imbalance in frail physiological cases. We propose to treat these patients with oral metronomic cyclophosphamide. Patients and methods This retrospective study analyses the data of patients with unresectable MM who received 50 to 100 mg of cyclophosphamide a day, 3 weeks out of 4. Main evaluation criterion was safety. Secondary evaluation criteria were objective response rate and overall survival. Results Thirteen patients were included (median age: 80, 5 AJCC stage III and 8 AJCC stage IV). Clinical and biological safety were good, leading to long home staying and rare treatment discontinuations. Main toxicity observed was lymphopenia; no opportunist infection occurred. The control rate was 46%: one partial response and five stable diseases (median: 10 months). Survival after beginning of treatment ranged from 4 to 37 months (median: 8 months). Discussion Literature about MM in frail elderly is limited. Still, specific treatment is necessary. Cyclophosphamide in metronomic schema was well tolerated. The response rate was difficult to assess (small population) but several patients presented with long lasting stabilisation. The mechanisms of action of this treatment are original, associating antiangiogenic action and immunomodulation. Conclusion Cyclophosphamide in metronomic schema showed good safety results for this frail population. Oral treatment enabled patients to stay at home longer and limited hospitalisation time. A larger controlled study will be necessary to confirm these encouraging results in elderly with MM, a classical chemoresistant tumor.

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Authors and Affiliations

  1. Clinique de Dermatologie, Centre Hospitalier Régional et Universitaire, Université Lille 2, Lille, France

    Estelle Borne, Eve Desmedt, Cyril Maire, Valérie Florin, Sophie Vercambre-Darras & Laurent Mortier

  2. Département de Biostatistiques, Université Lille 2, Lille, France

    Alain Duhamel

  3. Département de Radiothérapie, Centre Oscar Lambret, Lille, France

    Xavier Mirabel

  4. Department of Modern Languages, Ecole Centrale de Lille, Cité Scientifique, Villeneuve d’Ascq, France

    Véronique Dziwniel

  5. Département de Chirurgie Plastique, Centre Hospitalier Régional et Universitaire, Lille, France

    Véronique Martinot

  6. Département de Cancérologie Générale, Centre Oscar Lambret, Lille, France

    Nicolas Penel

  7. Clinique de Dermatologie, Hôpital Claude Huriez, Rue Michel Polonovski, 59037, Lille cedex, France

    Laurent Mortier

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  1. Estelle Borne
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Correspondence to Laurent Mortier.

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Estelle Borne and Eve Desmedt have equal contribution.

Laurent Mortier and Sophie Vercambre-Darras are Co-Senior authors.

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Borne, E., Desmedt, E., Duhamel, A. et al. Oral metronomic cyclophosphamide in elderly with metastatic melanoma. Invest New Drugs 28, 684–689 (2010). https://doi.org/10.1007/s10637-009-9298-5

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  • DOI: https://doi.org/10.1007/s10637-009-9298-5

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