low dose chemo
Low-dose Chemotherapy Protocol Relies on Normalization of Tumor Blood Supply – an article from Massachusetts General Hospital.
If you search metronomic chemotherapy at clinicaltrials.gov, you will find at least 178 citations. While most oncologists will tell you that either low dose chemotherapy does not work, or that there has not been a randomized trial comparing standard of care to low dose metronomic, this concept is attracting plenty of attention from the academicians.
While cytotoxic chemotherapy works only through direct killing of cancer cells (and normal cells), low dose metronomic chemotherapy targets tumor vasculature, improves the host anti-cancer immune response, improves blood supply to the tumor (thereby increasing chemotherapy delivery to the tumor, as well as oxygen delivery, which then turns off HIF-1 alpha), and improves the tumor stroma to favor a host anti-tumor response.
Unfortunately, one size never fits all, so even low dose metronomic chemotherapy needs to be altered (dose and frequency) according to tumor response. The data continues to mount, and in the near-future, maximum tolerated dose chemotherapy, in the treatment of solid tumors, will no longer be the norm.

 

July 8th, 2019

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low dose chemo

“When Cancer Can’t Be Cured, Low-Dose Chemo Aims To Keep It In Check,” an article from CommonHealth, can be accessed here.

This article is interesting because it notes that an oncologist at Tufts Medical Center uses low dose metronomic chemotherapy. In addition, an oncologist at Mass. General Hospital believes it may potentiate the effectiveness of immunotherapy. And finally, Dr. Schilsky, the director of ASCO, says, “It’s an interesting theory. It’s supported to some extent by laboratory studies.”

Dr. Schilsky also stated “the highest quality trials that have been done so far have generally not proven low-dose chemo to be better than conventional chemo.” As stated in the article, there is no large study, which randomizes standard of care maximum tolerated dose chemotherapy against low dose metronomic chemotherapy.

Unfortunately, it is unlikely that a study like this will ever be done due to lack of funding. What I find extremely interesting is that Dr. Schilsky said that “the highest quality trials that have been done so far have generally not proven low-dose chemo to be better than conventional chemo.” I assume that when Dr. Schilsky uses the term “better,” he means affords the patient longer survival (although it is not clear what he actually means). But even if a trial were to be performed, and low dose chemotherapy did not allow patients to live longer than maximum tolerated dose, is it possible that the improved quality of life from low dose chemotherapy in fact makes it “better?”

December 6th, 2018

Posted In: cancer care

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