Retrospective study of impact of geriatric covariates on metronomic cyclophosphamide efficacy and tolerability

Metronomic cyclophosphamide is sometimes considered in older and frail patients with advanced cancer when disease-related symptoms affect quality of life and standard treatments are no longer suitable. A retrospective study at Université Lyon (France) evaluated the impact of patient-, tumor-, and treatment-related characteristics on the efficacy and safety of metronomic cyclophosphamed in patients aged ≥ 70 years with metastatic solid tumors. Thirty-seven patients were included. The median age was 84 years (range 70-96); 15 had prostate cancer, 8 had breast cancer, and 14 had other primary tumors. The median duration of metronomic cyclophosphamide treatment was 4 months. The median progression-free survival was 4 months in the breast cancer subgroup and 6 months in the prostate cancer subgroup. Overall dose intensity was 87%, with 62% of patients maintaining ≥ 90%. Treatment was generally well tolerated; only 5 grade ≥ 3 toxicities were reported, and 84% of patients remained at home during therapy. Notably, patients treated for ≥ 9 months had poorer performance status and functional scores at baseline. The authors conclude that metronomic cyclophosphamide appears to be a safe and potentially effective option for metastatic cancer in older and frail patients, including those with limited functional reserve.