Maintenance metronomic chemotherapy combined with conventional treatment for metastatic breast cancer patients

Abstract

Purpose: To evaluate the progression free survival, response rate and toxicity for patients who were treated with conventional therapy combined with metronomic chemotherapy. Methods: patients received either chemotherapy followed by maintenance metronomic chemotherapy with or without hormonal therapy or primarily treated with hormonal therapy concomitant with metronomic chemotherapy. Metronomic chemotherapy consists of cyclophosphamide 50 mg tablet daily and methotrexate 2.5 mg twice daily on days 2 and 5 weekly, continued until disease progression or development of unacceptable toxicity. Results: after median follow up of 18 months, 40 patients were assessed. The progression free survival was 52.5% and the median time to disease progression was 10.4 months. The overall clinical benefit (complete response [CR]+partial remission [PR]+stable disease [SD]) was 52.5 % with no G3 or G4 toxicities encountered for metronomic therapy. The median time to disease progression was 12.5 months for estrogen receptor (ER)+ve, human epidermal growth factor receptor 2 (Her2)–ve (progression free survival [PFS]: 67.5%) compared to 8 months for ER+ve, Her2+ve (PFS: 10%), 9 months for ER–ve, Her2+ve (PFS: 10%) and 8 months for triple negative (PFS: 12.5%). The difference was statistically significant (P=0.018). Conclusion: maintenance metronomic cyclophosphamide and methotrexate demonstrated efficacy and provided durable disease stabilization especially for ER positive patients. The low costs and minimal toxicity allow patients to continue treatment for several months and support its use as an additional therapeutic tool.

Keywords

• maintenance metronomic
• metastatic breast cancer