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:
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