Highlights
- •Metronomic chemotherapy (M-CT) for metastatic Breast Cancer (MBC) patients is dose dense administration of chemotherapy at lower doses than maximum tolerated dose, given at shorter free intervals, with proven effectiveness and lesser toxicity.
- •M-CT has multiple mechanisms of action in cancer cells including apoptosis, senescence, non-apoptotic cell death, immunogenic cell death, and antiangiogenic effects.
- •In view of its low toxicity, convenience of treatment at home, easiness of monitoring and follow-up via telemedicine, M-CT could be considered for treatment of MBC during COVID-19 pandemic.
Abstract
Metronomic chemotherapy (M-CT) is defined as dose dense administration of chemotherapy
at lower doses than maximum tolerated dose but at shorter free intervals, to obtain
a near continuous exposure of cancer cells to those potentially effective drugs. M-CT
is a useful strategy to obtain response, overcome resistance and reduce side effects,
with low costs. This review will focus on the use of M-CT in advanced breast cancer
(ABC). Cytostatic and cytotoxic effect on cancer cells, the anti-angiogenic and the
immunomodulatory effects are its main mechanisms of actions. Many clinical trials
proved the efficacy and tolerability of different monotherapies and combinations of
chemotherapeutic agents administered in metronomic doses and frequencies in ABC. M-CT
is a reasonable option for second and later lines of chemotherapy in metastatic breast
cancer including those with prior anthracycline or taxane exposure, older patients
and patients with comorbidities, and even as first-line in certain groups of patients.
The acceptable efficacy and low toxicity of oral metronomic chemotherapy makes it
a reasonable option during COVID-19 pandemic as well as in the post-COVID era which
is projected to last for some time.
Keywords
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Article Info
Publication History
Published online: June 29, 2020
Accepted:
June 24,
2020
Received in revised form:
June 23,
2020
Received:
May 13,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
