Metronomic Oral Combination of Vinorelbine and Capecitabine in Advanced Breast Cancer: is it Time to be Considered for Daily Clinical Practice?

This commentary summarizes the main mechanisms of action of metronomic chemotherapy (mCHT) aiming to define the criteria for selecting patients for this strategy. mCHT refers to the frequent, regular administration of drug doses designed to maintain a low, but active, range of concentrations of chemotherapeutic drugs during prolonged periods of time without inducing excessive toxicities. Major mechanisms of action, rather than a direct effect on the tumor volume, are inhibition of angiogenesis and stimulation of innate immune response. The effectiveness of this treatment strategy was confirmed in different trials, reporting percentages of Objective Response Rate of approximately 50% and Clinical Benefit Rate of 77%-80%. Basing on the patients’ characteristics outlined in different trials, the ideal patient for mCHT has HR+ve tumor, indolent disease or bone metastases. The easy schedule of metronomic chemotherapy, together with the very low incidence of severe toxicities are all valuable advantages to be considered, in particular in countries with limited access to innovative drugs. Studies exploring different areas of application for mCHT are ongoing.