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  • Review Article
  • Published:

Metronomics: towards personalized chemotherapy?

Nature Reviews Clinical Oncology volume 11, pages 413–431 (2014)Cite this article

Subjects

Key Points

  • Metronomic chemotherapy relies on frequent administration of a low dose of chemotherapy

  • Initially considered as an antiangiogenic therapy, metronomic chemotherapy is now regarded as a multi-target therapy with immunological properties, and direct effect on cancer stem cells

  • Many clinical studies have demonstrated activity in relapsed and/or refractory disease and several randomized studies are ongoing

  • Metronomic chemotherapy can be easily combined with drug repositioning and targeted therapies to generate more potent non-toxic regimens

  • Combined with tumour molecular analysis, metronomic chemotherapy is poised to move towards personalized chemotherapy

  • Metronomic therapy is a non-toxic, inexpensive strategy well-suited for global oncology

Abstract

Since its inception in 2000, metronomic chemotherapy has undergone major advances as an antiangiogenic therapy. The discovery of the pro-immune properties of chemotherapy and its direct effects on cancer cells has established the intrinsic multitargeted nature of this therapeutic approach. The past 10 years have seen a marked rise in clinical trials of metronomic chemotherapy, and it is increasingly combined in the clinic with conventional treatments, such as maximum-tolerated dose chemotherapy and radiotherapy, as well as with novel therapeutic strategies, such as drug repositioning, targeted agents and immunotherapy. We review the latest advances in understanding the complex mechanisms of action of metronomic chemotherapy, and the recently identified factors associated with disease resistance. We comprehensively discuss the latest clinical data obtained from studies performed in both adult and paediatric populations, and highlight ongoing clinical trials. In this Review, we foresee the future developments of metronomic chemotherapy and specifically its potential role in the era of personalized medicine.

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Figure 1: Mechanisms of action of metronomic chemotherapy.

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Acknowledgements

This work is supported by grants from Enfance & Santé/SFCE, and LNlavie and the Siric programme.

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Authors and Affiliations

  1. Service d'Hématologie & Oncologie Pédiatrique, AP-HM, 264 rue Saint Pierre, Marseille, 13385, France

    Nicolas André

  2. INSERM UMR 911, Centre de Recherche en Oncologie Biologique et Oncopharmacologie, Aix-Marseille University, 27 Boulevard Jean Moulin, Marseille, 13005, France

    Manon Carré

  3. Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, PO Box 81, Randwick, 2031, NSW, Australia

    Eddy Pasquier

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All authors researched data for this article, made a substantial contribution to discussion of content for the article, wrote the article, and edited the article before submission and after peer review.

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N.A. declares he receives consulting honorarium from Sanofi. The other authors declare no competing interests.

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André, N., Carré, M. & Pasquier, E. Metronomics: towards personalized chemotherapy?. Nat Rev Clin Oncol 11, 413–431 (2014). https://doi.org/10.1038/nrclinonc.2014.89

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