Marcus Schmidt

Patient-Reported Outcome in Metastatic Breast Cancer and Platinum-Resistant Recurrent Ovarian Cancer Patients Treated with Metronomic Cyclophosphamide ± Methotrexate: PROmetronomic

Introduction: Maintenance of subjective well-being and health-related quality of life (HRQoL) play a crucial role in the treatment of metastatic cancer. The metronomic chemotherapy (MCT) may be a favorable treatment option in metastatic breast cancer (MBC) and platinum-resistant recurrent ovarian cancer (ROC). The aim of this study was to evaluate the HRQoL of MBC and ROC patients treated with MCT. Methods: PROmetronomic was a prospective, monocentric study evaluating the HRQoL in MBC and ROC patients treated with oral cyclophosphamide 50 mg daily (+ oral methotrexate 2.5 mg every other day for MBC) from August 2020 to August 2022. The data were obtained using EORTC QLQ-C30, BR23, OV28, and HADS-D via the eHealth-based platform CANKADO. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety. Results: A total of 5 MBC patients and 9 ROC patients were evaluated. The mean global health status was 47.2 at baseline and 36.1 at the end of MCT (p = 0.350). Functional scales and symptoms remained stable during MCT except for the significant increase of fatigue (51.9 vs. 77.8, p = 0.038). Anxiety and depression were without significant alteration (9.1 and 8.1 at baseline vs. 9.3 and 8.1 after MCT). The median PFS and OS were 10.0 weeks and 28.0 weeks, respectively. No ≥grade 3 toxicities were reported. Conclusion: MCT had no significant impact on HRQoL of our small cohort of heavily pretreated MBC and ROC patients and may represent a valuable treatment option for maintaining HRQoL in selected patients.

Impact of Epidural Anesthesia on the Outcome of Elderly Patients with Endometrial Cancer: Results of a Propensity Score-Matched Analysis

Introduction: Epidural anesthesia is a standard procedure to mitigate pain during surgery for endometrial cancer (EC). Little data exist about the influence of epidural anesthesia on the oncological outcome in elderly patients with EC. This retrospective study aimed to investigate potential correlations between epidural anesthesia and cancer recurrence in patients with EC. Methods: We screened the medical records of patients ≥60 years treated surgically for EC at the University Medical Center Mainz between January 2008 and December 2019. All women underwent general anesthesia (GA) alone or combined with epidural anesthesia (EGA). Cox regression, the Kaplan-Meier method and propensity score matching were used to analyze the prognostic influence of the anesthesiologic regime on survival. Results: A total of 152 women with EC were included. Twenty-nine patients (19.1%) formed the EGA cohort. The median time of follow-up (FU) was 31 months (interquartile range [IQR]: 8–67.5). The EGA cohort showed more in-hospital complications (27.6 vs. 8.9%; p = 0.006), especially thromboembolic events (3 vs. 0 events; p = 0.006), as well as a longer hospital stay (11 [IQR: 8–13] vs. 7 [IQR: 4–9] days; p < 0.001). Twenty-six patients (17.1%) developed a recurrence in the follow-up at a median of 13 months [IQR: 7.75–29.5]. Thirty-two patients died during FU (21.1%). The EGA cohort showed higher FIGO stages and a higher histological grading than the GA cohort. In the Kaplan-Meier analysis, EGA showed a significantly reduced 5-year recurrence-free survival (RFS) (36.5% vs. 72.6%, p < 0.001) and overall survival (OS) (58.6% vs. 79.9%, p = 0.008). However, in multivariate Cox regression analysis including FIGO stages and histological grading, EGA did not influence RFS (HR: 2.02; 95%-CI: [0.99–4.12], p = 0.054), and OS (HR: 1.03; 95%-CI: [0.40–2.66], p = 0.951). This was backed up by the propensity score- matched analysis for survival (RFS: p = 0.604, OS: p = 0.86). Conclusion: Considering risk factors, epidural anesthesia in combination with GA did not differ in recurrence-free and overall survival compared to GA. Prospective randomized trials are warranted in order to further evaluate this topic.