Cyclophosphamide "metronomic" chemotherapy for palliative treatment of a young patient with advanced epithelial ovarian cancer

We tried palliative chemotherapy with daily low dose oral cyclophosphamide with a patient suffering from stage IIIC ovarian cancer that responded to daily cyclophosphamide (CTX) after no response to chemotherapy with paclitaxel and carboplatin as first line and progression after second line with topotecan.The progression-free survival time on daily low dose oral cyclophosphamide treatment was 65 months without side effects. She was well during the chemotherapy and lived a normal working and social life.We think that use of low dose of oral CTX should be investigated further as a strategy against tumour progression after standard chemotherapy in patients who are platinum resistant with poor performance status.Ovarian cancer remains the most common cause of death from a gynaecologic malignancy. In 2005, it is estimated that over 22,000 women will develop ovarian cancer and 16,210 will die as a result [1].Current treatment of ovarian cancer entails a combination of surgery and chemotherapy. Currently, 1st-line chemotherapy consists of a combination of carboplatin and paclitaxel to which approximately 80% of women respond [2].However, despite aggressive surgery and chemotherapy, more than 80% of patients will relapse and will then be treated with second line chemotherapy with objective responses in about 20% of patients and even lower percentages of complete responses. This is why the main goal of second and third line chemotherapy is palliative care with the aim to prolong time to progression and to improve quality of life.Several chemotherapeutic regimens have been used as single agents in phase II trials with patients previously treated with cisplatin including paclitaxel, topotecan, liposomal doxorubicin, gemcitabine and oxaliplatin, showing objective response rates ranging from 10–50% and different toxicity profiles [3].Many factors play a role when choosing a drug, such as patient compliance, toxicity of previous treatments and treatment costs. Because, at present