Capecitabine “metronomic” chemotherapy for palliative treatment of elderly patients with advanced gastric cancer after fluoropyrimidine-based chemotherapy

Abstract

We aimed to study the efficacy and safety of metronomic capecitabine in pretreated elderly patients with advanced gastric cancer. Eligible patients with advanced gastric cancer were treated with capecitabine at a fixed dose 1,000 mg daily (days 1-28 continuously, every 5 weeks) until disease progression or significant toxicity. Tumor response was assessed every 10 weeks by computed tomography scan using Response Evaluation Criteria in solid tumors. In total, 45 patients were enrolled, of whom 43 were evaluated for efficacy and 45 for safety. A median of 3 cycles (range 1-12) were administered. Metronomic chemotherapy had a disease control rate (DCR) at 8 weeks of 51.1% (95% CI 25.7-67.8), and the objective response rate was 20.9% (95% CI 13.1-38.5, 9 of 43 assessable patients). The median time-to-progression and median overall survival were 3.6 months (95% CI: 3.2-4.0 months) and 7.6 months (95% CI 7.0-8.2 months), respectively. Grade II neutropenia and thrombocytopenia were observed in 13.3 and 2.2% of patients, respectively. Grade II/III nonhematological toxicities included diarrhea (4.4%), stomatitis (13.4%), and hand-foot syndrome (15.5%). No grade IV toxicity, neutropenic fever or treatment-related deaths occurred. Metronomic capecitabine was effective and well tolerated as palliative treatment in elderly patients with advanced gastric cancer after fluoropyrimidine-based chemotherapy.

Metronomic chemotherapy from rationale to clinical studies: A dream or reality?

“…No grade IV toxicity occurred. This single data suggest that metronomic capecitabine can sustain a response, as palliative treatment in elderly patients even pretreated with fluoropyrimidine-based chemotherapy [96] (Table 5).…”

Metronomic Chemotherapy: A Systematic Review of the Literature and Clinical Experience

“…The median TTP was 3.6 months and median OS was 7.6 months. No grade 4 toxicity was observed [202]. Weekly paclitaxel with lower doses of 80 mg/m 2 was retrospectively evaluated on patients with unresectable esophageal cancer.…”

Low-dose Metronomic Capecitabine (Xeloda) for Treatment of Metastatic Gastrointestinal Cancer: A Clinical Study

“…After absorption from the gastrointestinal tract, capecitabine is enzymatically converted to 5-FU. The conversion to 5-FU occurs in several steps, where the enzyme responsible for the final step is called thymidine phosphorylase [29]. Since thymidine phosphorylase is located at much higher concentrations in tumor tissue than in normal tissues, the active form of the drug is mainly present at the tumor site [30].…”