Use of metronomic chemotherapy in oncology: Results from a national Italian survey

ABSTRACT Aimsandbackground.Metronomicchemotherapyreferstotheadministrationoflowdoses of cytotoxic agents over a prolonged period of time with no or only short drug-free intervals. It is designed to overcome acquired tumor resistance to chemotherapyand reduce neo-angiogenesis despite a lower toxicity than with standard chemother -apy. The role of metronomic chemotherapy remains controversial, and its optimaltherapeutic use has not yet been defined.Methodsandstudydesign.The present survey was designed as a short questionnaireand was sent to the medical oncologists registered with Medikey, a national databaselisting all the Italian oncology specialists linked with the Italian Council of MedicalOncology Hospital Consultants ( Collegio Italiano Primari Oncologi Medici Os -pedalieri , CIPOMO) and the Italian Association of Medical Oncology ( AssociazioneItaliana di Oncologia Medica , AIOM). The questionnaire was completed on a volun -tary basis and it was totally anonymous.Results. The questionnaire was sent to 3,289 oncologists, and 191 (5.8%) actively par -ticipated in the survey. Seventy-two percent of responders declared that they had ad -ministered a regimen of metronomic chemotherapy at least once. Metronomicchemotherapy is commonly used in advanced breast cancer patients, and in most cas -es it was prescribed after failure of at least two lines of treatment. Oral agents such ascyclophosphamide, capecitabine, methotrexate and vinorelbine were the most com -monly prescribed drugs. Nearly 60% of responders was believed to have significantlyless toxicity with metronomic chemotherapy than with standard chemotherapy.Conclusions: The sample of oncologists who participated in the survey is small but itappears to be representative of the Italian medical oncology community.The answersto the questionnaire indicate a significant interest in metronomic chemotherapy,whichisapparentlywidelyprescribed.Thisisthefirstlargenationalsurveyontheuseof metronomic chemotherapy. Considering the results, larger research on metro -nomic chemotherapy is strongly warranted.IntroductionThe definition of metronomic chemotherapy (MCT) generally refers to the admin -istration of low doses of cytotoxic agents given orally in most cases over a prolongedperiod of time with no or only short drug-free intervals. This strategy differs substan -tially from the traditional paradigm of pulsed administration of the maximum toler -ated dose of chemotherapeutic drugs at fixed intervals (generally every three or fourweeks)andappearstobeassociatedwithsomesignificantadvantages.MCTwasorig -inally developed to overcome drug resistance by shifting the therapeutic target from