Bevacizumab with metronomic chemotherapy of low-dose oral cyclophosphamide in recurrent cervical cancer: Four cases.
Bevacizumab with metronomic chemotherapy of low-dose oral cyclophosphamide in recurrent cervical cancer: Four cases.
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DOI：
10.1016/j.gore.2018.04.001
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发表时间：
2018-05
影响因子：
1.2
通讯作者：
Shibahara H
中科院分区：
文献类型：
--
作者：
Isono-Nakata R;Tsubamoto H;Ueda T;Inoue K;Shibahara H
晚期或复发性宫颈癌女性的标准化疗包括紫杉醇、铂和贝伐单抗的联合治疗。但是，对于紫杉醇或铂类药物过敏反应、永久性周围神经病变或一线化疗期间出现早期复发或疾病进展的患者，必须开发非紫杉烷类非铂类药物治疗方案。使用抗血管生成治疗的临床试验证明了高度血管化的宫颈癌病例的良好结局。节拍化疗被认为是一种抗血管生成治疗，尽管其与贝伐单抗联合使用尚未在宫颈癌中进行研究。我们治疗了4例复发性宫颈癌患者，每天口服50 mg环磷酰胺，每3周静脉注射15 mg/kg贝伐单抗（CFA-BEV）。1例患者在4个月后出现疾病进展，而其他3例患者继续接受该方案，直至分别在13、14和15个月进行末次随访。1例患者发生3级中性粒细胞减少症;然而，未观察到2级或更高级别的非血液学毒性。这些病例证明了使用具有最小毒性和预期抗癌活性的CFA-BEV，并表明该方案应考虑用于晚期复发性宫颈癌的二线化疗。非紫杉类、非铂类方案作为复发性宫颈癌的二线治疗是必要的。使用抗血管生成药物的临床试验显示，高度血管化的宫颈癌患者预后更好。节拍化疗已被证明可以抑制血管生成。这是第一例报告节拍化疗与贝伐单抗在宫颈癌。
Standard chemotherapy for women with advanced or recurrent cervical cancer involves a combination of paclitaxel, platinum, and bevacizumab. However, for patients who experience anaphylaxis in response to paclitaxel or platinum, have permanent peripheral neuropathy, or develop early recurrence or progressive disease during first-line chemotherapy, the development of a non-taxane non-platinum regimen is mandatory. Clinical trials using anti-angiogenic treatment demonstrated favorable outcomes in cases of highly vascularized cervical cancer. Metronomic chemotherapy has been considered an anti-angiogenic treatment, although its use in combination with bevacizumab has not been studied in cervical cancer. We treated four patients with recurrent cervical cancer with 50 mg of oral cyclophosphamide daily and 15 mg/kg of intravenous bevacizumab every 3 weeks (CFA-BEV). One patient experienced disease progression after 4 months, whereas the other three patients continued the regimen until their last follow-up at 13, 14, and 15 months, respectively. One patient suffered from grade 3 neutropenia; however, no grade 2 or higher non-hematological toxicities were observed. These cases demonstrate the use of CFA-BEV with minimal toxicity and expected anti-cancer activity and indicate that this regimen should be considered for second-line chemotherapy in advanced recurrent cervical cancer. Development of non-taxane, non-platinum regimen is warranted in the second line treatment of recurrent cervical cancer. Clinical trials using anti-angiogenetic drugs showed better outcomes in cases of highly vascularized cervical cancer. Metronomic chemotherapy has been shown to inhibit angiogenesis. This is the first case report of metronomic chemotherapy with bevacizumab in cervical cancer.