Metronomic Chemotherapy in Pediatric Oncology: From Preclinical Evidence to Clinical Studies

Abstract

Metronomic chemotherapy (MC) is the frequent, regular administration of drug doses designed to maintain a low, but active, range of concentrations of chemotherapeutic drugs, during prolonged periods of time without inducing excessive toxicities. To date, more than 400,000 children and adolescents under the age of 20 are diagnosed with cancer, per year, with 80% survival in most high-income countries, but less than 30% in low- and middle-income ones. In this review, we summarized the principal preclinical and clinical studies involving the use of MC in the most common pediatric tumors, with an overview of efficacy, toxicity, pharmacokinetic profile, and biomarkers. The best advantages of MC are low toxicity, oral administration and, thus, the feasibility of a more comfortable, home-based treatment, therefore improving the quality of life of the children themselves and of their parents and caregivers. Moreover, MC could represent a valid method to reduce the economic burden of anticancer therapy in the pediatric setting.

Complete Remission of a Diffuse Large B-Cell Lymphoma in a Young Patient, with Severe Tuberous Sclerosis, Treated with Metronomic Chemotherapy and Ibrutinib: A Case Report

“…Metronomic chemotherapy (mCHEMO) is the frequent, regular administration of drug doses able to maintain a low, but active, range of concentrations of chemotherapeutic drugs, during prolonged periods of time without inducing important toxicities [9]. The major advantages of mCHEMO are the multiple mechanisms of action [10], the easiness to combine with target therapies [11], the low toxicity, the oral administration, and, therefore, the feasibility of a more comfortable, home-based treatment [12]. The all-oral metronomic schedule DEVEC, including vinorelbine, cyclophosphamide, etoposide, and prednisone +/− rituximab, showed very promising results in treatmentnai €ve and relapsed/refractory (R/R) elderly subjects, with B and T-cell aggressive NHL compared with a real-life setting of patients treated with systemic chemotherapy [13][14][15][16].…”