Highlights from the 1st Latin American meeting on metronomic chemotherapy and drug repositioning in oncology, 27–28 May, 2016, Rosario, Argentina

Abstract

Following previous metronomic meetings in Marseille (2011), Milano (2014), and Mumbai (2016), the first Latin American metronomic meeting was held in the School of Medical Sciences, National University of Rosario, Rosario, Argentina on 27 and 28 of May, 2016. For the first time, clinicians and researchers with experience in the field of metronomics, coming from different countries in Latin America, had the opportunity of presenting and discussing their work. The talks were organised in three main sessions related to experience in the pre-clinical, and clinical (paediatric and adult) areas. The different presentations demonstrated that the fields of metronomic chemotherapy and repurposing drugs in oncology, known as metronomics, constitute a branch of cancer therapy in permanent evolution, which have strong groups working in LatinAmerica, both in the preclinical and the clinical settings including large, adequately designed randomised studies. It was shown that metronomics offers treatments, which, whether they are combined or not with the standard therapeutic approaches, are not only effective but also minimally toxic, with the consequent improvement of the patient’s quality of life, and inexpensive, a feature very important in low resource clinical settings. The potential use of metronomic chemotherapy was proposed as a cost/effective treatment in low-/middle-income countries, for adjuvant therapy in selected tumours. The fundamental role of the governmental agencies and non-governmental alliances, as the Metronomic Global Health Initiative, in supporting this research with public interest was underlined.

Widely disseminated metastatic Ewing sarcoma: Sustained, complete metabolic response to first‐line oral metronomic chemotherapy

“…However, being extremely chemosensitive, standard first‐line treatment involves intravenous (IV) chemotherapy, including vincristine, adriamycin, Cy with sequential ifosfamide, and Eto and consideration for local therapy depending upon the response, especially in high‐income countries with no resource limitations 3,4 . OMCT is commonly used in patients with relapsed/refractory cancers, poor ECOG PS, and situations where definitive therapy may not be possible or as consolidation therapy in high‐risk cases 5,17,18 . This may be the first case report of sustained CMR, even 18 months after stopping all therapy, with the use of first‐line OMCT in an adult with disseminated metastatic ES.…”

“…Another study using metronomic celecoxib and vinblastine with standard IV chemotherapy in newly diagnosed metastatic ES showed survival benefit 20 . In metastatic ES, the preliminary reports suggest improved survival with the use of maintenance vinblastine and Cy after the completion of intensive chemotherapy 18 …”

Metro‐SMHOP 01: Metronomics combination with cyclophosphamide‐etoposide and valproic acid for refractory and relapsing pediatric malignancies

“…14 For low-and middle-income countries, metronomics has been foreseen as a potential way to overcome many barriers to anticancer treatment such as cost and toxicities. 4 Over the last few years, a growing number of publications have investigated the potential role of metronomics for children in LMIC, 4,14,20,24,[26][27][28] and a recent international survey has confirmed the interest of pediatric oncologists working in LMIC for this approach, especially for palliative care or as a maintenance for patients with high-risk disease. 29 Indeed, access to newer therapies such as targeted therapies or immunotherapies is very limited in LMIC.…”

Metronomic therapy in pediatric oncology: A snapshot

“…Experts from developed and developing low‐ and middle‐income countries have joined hands in serial International Workshops of Metronomics conducted by Metronomic Global Health Initiative (metronomic.org) …”

“…Likewise, a single‐arm study of a low‐dose anti‐angiogenic regimen of vinblastine and celecoxib in Ewing sarcoma following completion of treatment revealed limited usefulness as there was excess toxicity . However, metronomic maintenance with vinblastine and cyclophosphamide in Ewing Sarcoma after intensive chemotherapy showed a statistically insignificant better event‐free survival and OS compared to no maintenance …”