Metronomic Chemotherapy in Elderly Patients

Abstract

Purpose of review: This review describes the most relevant studies found in the scientific literature regarding metronomic chemotherapy (MCT) in the geriatric oncology population to support its use as a feasible treatment of care in the frail elderly patients.

Recent findings: Recent years have seen a reevaluation of cancer chemotherapeutic drugs and MCT is an emerging schedule in phase II and III clinical trials. Ageing is one of the risk factors for the development of cancer, the incidence of whom increases dramatically in people who live longer. To date, standard oncological protocols involve chemotherapeutic drugs in short cycles of therapy at the maximum tolerated dose (MTD). Although these therapeutic regimens may be successful, they can cause important adverse drug reactions, especially in elderly or frail patients. MCT is a different modality of delivery of chemotherapeutic drugs (frequent low dose for prolonged time) and it looks at the overcoming of the limitations and disadvantages of MTD, in particular the toxicity aspect. We reviewed the experience of clinicians who have used MCT in clinical trials enrolling elderly patients with different cancer types.

Keywords: Elderly patients; Geriatric oncology; Low-dose regimen; Metronomic chemotherapy.

Fig. 1

Effects of metronomic chemotherapy (MCT) on cancer cells, immune and vascular system. CSC, cancer stem cell; HIF-1, hypoxia-inducible factor-1; Treg, regularity T cell; TSP-1, thrombospondin-1; VEGF, vascular endothelial growth factor