Metronomic Chemotherapy for Metastatic Breast Cancer – a Systematic Review of the Literature

Abstract

Conventional chemotherapy is generally administered in high doses followed by a treatment-free period to give the body needful time to recover. This “maximum tolerated dose” approach results in high response rates. However, long periods between therapy cycles can lead to development of resistance mechanisms and consequently disease progression. One of the most interesting alternative strategies is metronomic chemotherapy. This concept relies on the continuous administration of chemotherapy at low doses and aims at targeting endothelial cells in the tumor bed as well. Recently, metronomic chemotherapy has been incorporated into the recommendations issued by the German AGO expert panel (www.ago-online.de). A systematic review of PubMed/Medline, ClinicalTrials.gov, the European Clinical Trials Database (EudraCT) and the Cochrane Database was conducted. In the present review, we discuss the current evidence on metronomic chemotherapy in metastatic breast cancer.

Zusammenfassung

Die herkömmliche Chemotherapie wird üblicherweise in hohen Dosen verabreicht, gefolgt von einer behandlungsfreien Periode, die dem Körper die nötige Erholungszeit gibt. Dieser Ansatz, bei welchem dem Patienten die „maximal verträgliche Dosis“ verabreicht wird, ist mit hohen Ansprechraten verbunden. Die langen Abstände zwischen den einzelnen Therapiezyklen können jedoch die Entwicklung von Resistenzmechanismen begünstigen und folglich zu einem Fortschreiten der Erkrankung führen. Die metronomische Chemotherapie stellt daher eine interessante Alternative dar. Das Konzept beruht auf der kontinuierlichen Verabreichung eines niedrig dosierten Chemotherapeutikums und zielt auch auf die Endothelzellen im Tumorbett ab. Vor Kurzem wurde die metronomische Chemotherapie in die vom Expertengremium der AGO herausgegebenen Empfehlungen aufgenommen (www.ago-online.de). Es wurde eine systematische Recherche in PubMed/Medline, ClinicalTrials.gov, European Clinical Trials Database (EudraCT) sowie Cochrane Database durchgeführt. In der hier vorgestellten Literaturübersicht werden die aktuellen Erkenntnisse über die metronomische Chemotherapie bei der Behandlung von metastasierendem Brustkrebs diskutiert.

Key words

breast cancer - metronomic chemotherapy - survival - toxicity - systematic review

Schlüsselwörter

Brustkrebs - metronomische Chemotherapie - Überleben - Toxizität - systematische Recherche

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