Esorubicin

The recent coronavirus disease 19 (COVID-19) crisis has resulted in an economic downturn and the implementation of policies such as social distancing and shelter-in-place.1 In light of these events, the US government has passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. This act relaxed Health Insurance Portability and Accountability Act regulations and instituted new avenues of revenue for telehealth, including (1) real-time audio-video technology communication; (2) store-and-forward technology, which collects data to be later transmitted via virtual check-ins, email, or other digital applications; and (3) verbal/audio-only communication without images or prerecorded videos.2 Moreover, latest polls have found that around two-thirds of patients are willing to try telehealth because of the pandemic.3 These factors have allowed physicians to provide virtual care for patients who are receptive to such technology while adhering to newly instituted policies. The various treatment options for keratinocyte carcinomas (KCs)—surgery, radiation, lasers, curettage and electrodesiccation, photodynamic therapy, intralesional chemotherapy, and cryotherapy—require in-person office visits for implementation.4 Currently, effective treatment options for KCs that allow for entirely no in-person visits are unknown or limited. The combination of topical antitumor agents (imiquimod 5% cream [IMI], 5-fluorouracil 2% solution [5-FU], and tretinoin 0.1% cream [TRET]) with limited cryotherapy was found to be efficacious in the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).5 With the recent institution of social distancing, we evaluated the use of store-and-forward technology with this combination (IMI/5-FU/TRET) for the treatment of KCs that required no in-office patient visits.

Patients with a pathologically confirmed diagnosis of metastatic or advanced epithelial-type ovarian carcinoma were entered into a Phase II trial of esorubicin. Eligibility criteria included measurable disease; performance status (SWOG) 0-2; no more than one prior chemotherapeutic regimen; and no prior doxorubicin therapy. The starting esorubicin dosing schedule was 30 mg/m2 every 3 weeks for good risk patients and 25 mg/m2 every 3 weeks for poor risk patients. Twenty-one patients were eligible for evaluation of response and toxicity to treatment. These patients received a median of 3 courses of esorubicin (range 1-13 courses). None of the 21 patients experienced a response to esorubicin. Median survival was 5.5 months. Leukopenia was the major toxicity. Eleven (79%) of the good risk patients and 2 (29%) of the poor risk patients experienced severe to life-threatening leukopenia. Mild to severe anemia was seen in 10 (71%) of the good risk patients and 7 (100%) of the poor risk patients. We conclude that esorubicin is ineffective in the treatment of ovarian cancer patients who have received primary chemotherapy.