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Case Reports
. 2018 Apr 6:24:57-60.
doi: 10.1016/j.gore.2018.04.001. eCollection 2018 May.

Bevacizumab with metronomic chemotherapy of low-dose oral cyclophosphamide in recurrent cervical cancer: Four cases

Rose Isono-Nakata  1 , Hiroshi Tsubamoto  1 , Tomoko Ueda  1 , Kayo Inoue  1 , Hiroaki Shibahara  1
Affiliations
Case Reports

Bevacizumab with metronomic chemotherapy of low-dose oral cyclophosphamide in recurrent cervical cancer: Four cases

Rose Isono-Nakata et al. Gynecol Oncol Rep. .

Abstract

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.

Keywords: Bevacizumab; Cervical cancer; Metronomic chemotherapy.

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Figures

Fig. 1
Fig. 1
Stable disease of lung metastases during CFA-BEV treatment in case 1. Images from computed tomography performed before (A) and 14.8 months after (B) the initiation of CFA-BEV treatment. The arrow shows the maximum size of the lung metastases (diameter, 10 mm).
Fig. 2
Fig. 2
Decreased 18F-fluoro-deoxyglucose uptake of paraaortic lymph node during CFA-BEV treatment in case 4. The short axis was 8.7 mm in diameter, and the maximum standard uptake value (SUVmax) was 2.7 (A) before CFA-BEV initiation. After 5.1 months, the SUVmax decreased to 2.4 (B); no abnormal uptake was detected 9.9 months (C) and 13.8 months after treatment. The arrow indicates the paraaortic lymph node.
See this image and copyright information in PMC

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