Metronomic cyclophosphamide with cisplatin and bevacizumab: a new chemotherapeutic regimen for refractory anaplastic ependymoma.

UNLABELLED Anaplastic ependymoma is a rare brain tumor, induced both in the brain and the spine. The treatment relies on surgery and radiotherapy. Upon failure of these treatments, chemotherapy has modest effects. Here, we report two cases of anaplastic ependymoma with prolonged radiological and clinical responses to a metronomic cyclophosphamide, cisplatin and bevacizumab regimen. Two patients with anaplastic ependymoma, refractory to surgery and radiotherapy were proposed for a chemotherapeutic treatment. These patients had both spina and brain nodules. Neurological symptoms included arm deficiencies and paraparesia. RESULTS Six cycles of the metronomic cyclophosphamide (50 mg per day, daily), cisplatin (100 mg/m(2) every four weeks) and bevacizumab (10 mg/kg every two weeks), as a chemotherapeutic regimen, induced both radiological response on magnetic resonance imaging and clinical response with neurological deficiency regression. At one year, the patients were still under maintenance therapy with metronomic cyclophosphamide and cisplatin. This treatment still continues to control tumor progression and symptoms. CONCLUSION This is the first report showing an impressive efficacy of metronomic the cyclophosphamide, cisplatin and bevacizumab chemotherapeutic regimen for the treatment of refractory anaplastic ependymoma.