Metronomic Chemotherapy
What is Metronomic Chemotherapy?
Metronomic chemotherapy is a type of cancer treatment that involves giving lower, more frequent doses of chemotherapy drugs over an extended period, often without long breaks between cycles.
Unlike traditional chemotherapy, which typically involves higher doses given at specific intervals, metronomic chemotherapy aims to continuously target cancer cells with lower doses, reducing the toxic effects on normal cells.
This type of treatment is also thought to be more cost-effective because it involves a lower dose of drugs as compared to traditional chemotherapy.
Metronomic chemotherapy involves targeting the blood vessels that support tumor growth, disrupting their formation, and limiting the blood supply to the cancer cells. This can help slow down tumor growth and reduce the risk of resistance to treatment.
Metronomic chemotherapy is often considered for certain types of cancers, and its gentler nature leads to fewer side effects compared to traditional chemotherapy.
How is Metronomic Chemotherapy Given?
Cyclophosphamide, piroxicam, and frusemide are the most common drugs used in metronomic therapy. These are taken orally at home.
Before starting metronomic chemotherapy, baseline data is required to assess the malignancy and overall health.
Measurements of existing tumors are taken by examination of a visible tumor outside the body, radiography, or ultrasound for internal tumors.
Advantages of metronomic chemotherapy in ER+/HER2- metastatic breast cancer
Metronomic Therapy Side Effects
Metronomic chemotherapy is a treatment approach that uses lower doses of drugs given more frequently. Here are the key points about its side effects:
Milder Side Effects: Compared to traditional chemotherapy, metronomic chemotherapy generally causes fewer and less severe side effects because of its lower doses.
Common Side Effects:
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- Mild nausea or vomiting
- Mild to moderate anemia (low red blood cell count)
- Neutropenia (low white blood cell count)
- Leucopenia (low white blood cells overall)
- Lymphopenia (low lymphocytes, a type of white blood cell)
- Low-grade fatigue
Specific Side Effects in Some Studies:
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- Hand-foot syndrome (5-9% of patients, with more severe cases in 3% of them)
- Elevated liver enzymes (5% experienced more severe cases)
- Severe neutropenia (4.5-5% of patients had grade 3-4 levels)
Less Need for Supportive Therapy: Because metronomic chemotherapy has lower toxicity, patients often don’t need as much supportive care (like extra medications to manage side effects) compared to conventional chemotherapy.
Fewer Severe Side Effects: Some studies reported no grade 3-4 (severe) side effects at all.
Rare Severe Toxicity: One study using vinorelbine reported a rare, fatal side effect (grade 5 toxicity), but this was uncommon.
Overall Tolerability: Metronomic chemotherapy is usually well-tolerated with manageable side effects, making it easier for patients to continue treatment over the long term.
Steady Drug Levels: The lower, more frequent doses of drugs maintain steady low levels in the bloodstream, reducing the risk of significant toxic effects.
Varying Side Effects: The exact side effects can vary based on the specific drugs and drug combinations used in metronomic chemotherapy.
In Summary, While metronomic chemotherapy does have side effects, they tend to be milder than those caused by traditional chemotherapy. This approach can be given over a longer period with less impact on patients' quality of life.
Research on Metronomic Chemotherapy
Metronomic chemotherapy is an effective and low-cost treatment of several types of tumors.
Here is some of the latest research:
Metronomic Therapy for Breast Cancer
Metronomic administration of oral chemotherapy is a promising treatment strategy for some patients with Metastatic Breast Cancer and inhibits tumor progression via multiple mechanisms of action.
Head and Neck
Oral metronomic chemotherapy is non-inferior to intravenous cisplatin with respect to overall survival and is associated with fewer adverse events.
A recent Phase 3 study confirmed these conclusions.
Ovarian
In summary, based on the clinical responses obtained and the low toxicity of the treatment, metronomic chemotherapy and drug repurposing are options to be taken into account for Ovarian cancer patients.
- The treatment with low doses of cyclophosphamide resulted in therapeutic response, ranging from a near clinical complete response to a long stable disease.
- Metronomic chemotherapy with oral cyclophosphamide presented a low toxicity profile and did not affect the patient’s quality of life.
Prostate cancer
A 2022 study looked at nearly 1000 cases of Metastatic castration-resistant prostate cancer, one of the most lethal forms of prostate cancer. The study found low-dose metronomic chemotherapy to be a well-tolerated and cost-effective form of cancer therapy, especially for patients who are older or unfit and who are unable to tolerate conventional mCRPC therapies.
Frequently Asked Questions
Metronomic chemotherapy may be effective for certain types of cancers, particularly in controlling tumor growth over the long term, but its effectiveness varies and is still being researched.
Patients with slow-growing cancers, those who have had toxic side effects from standard chemotherapy, or those looking for a maintenance therapy may be good candidates.
Treatment duration varies depending on the patient's cancer type and progression, but it is often given for an extended period, sometimes continuously, as long as it remains effective.
Success rates vary based on cancer type, stage, and patient health, but it has shown promise in extending survival and controlling tumor growth in certain cancers.
It is available in many countries, but its use may depend on the availability of specific drugs and protocols. It is more commonly offered in specialized cancer centers.
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