Chemotherapy remains at the core of much current cancer treatment. Along with radiotherapy and surgery, it’s one of the big three that nearly every cancer patient has to face in the treatment of disease. Many of the ‘classical’ chemotherapy drugs have been in clinical use for decades now, and you would think we would know all there is to know about how best to use them. Unfortunately it appears not...
The most common approach to chemotherapy is the multi-drug maximum tolerate dose (MTD) protocol. Here you take a set of drugs that work in slightly different ways and then blast them into the patient in a fixed pattern and at the highest possible dose. These cocktails are incredibly toxic – they knock out cancer cells but at considerable collateral damage. Patients lose hair, suffer sickness, loss of immune system, suffer damage to the heart and other organs. It’s a horror and nobody looks forward to chemo. On the plus side there is often a considerable amount of tumour kill, at least at the beginning. But very often tumours develop resistance, the drugs stop being effective and the side effects continue.
However, there is an alternative approach to using these drugs called metronomic chemotherapy. This involves giving considerably lower doses of these drugs but much more frequently. Here, instead of blasting the patient with chemo and then leaving them for a couple of weeks while they recover from the blast – time in which the tumour can also recover – you give a steady drip-drip of the drugs instead. The side effects are considerably lower and quality of life is much higher – especially as the drugs are usually given in tablet form on an out-patient basis.
This isn’t necessarily a new approach, people have been using metronomic approaches for many years now, but they are not routine. Mostly when they are used it’s as a maintenance therapy or in a palliative care situation – even though there is evidence that this approach can be effective as a first-line therapy.
There’s a lot more that can be said about the metronomic approach, and it’s a topic I intend to return to in the future, but for now let me point you to a recent paper on the subject. My colleague from the ReDO project, Dr Gauthier Bouche, attended the recent Fourth Metronomic and Anti-angiogenic Therapy Meeting, where he gave a presentation on our work in ReDO. He has also taken the lead in writing a very readable and interesting report from the conference, published at ecancer. It’s full of useful information and references and a good place to look if you are interested in looking for alternatives or new treatment options: