Palma Fedele, Valeria Sanna, Alessandro Fancellu, Antonella Marino, Nicola Calvani, and Saverio Cinierid from the Medical Oncology, Dario Camberlingo Hospital, Francavilla Fontana , the Medical Oncology, Hospital of Sassari, Sassari, the Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery, University of Sassari, and the Medical Oncology & Breast Unit, Antonio Perrino Hospital, Brindisi, Italy have published in Crit Rev Oncol Hematol. an opinion piece entitled : De-escalating cancer treatments during COVID 19 pandemic: Is metronomic chemotherapy a reasonable option?

The coronavirus disease 2019 (COVID-19) pandemic has forced healthcare systems to reorganize all the activities with the purpose of containing the virus infection. Medical resources have been concentrated on emergency departments and intensive care units while scheduled and non-urgent medical services have been suspended. The reorganization of the healthcare system has had an important impact on the management of cancer patients. Cancer patients are considered at high risk of developing coronavirus infection and its severe complications, because of their illness and immunosuppressed status

Recommendations and guidelines on how to manage cancer patients during COVID 19 pandemic have been published. Oral administration of chemotherapy is recommended to limit the access of cancer patients to hospital facilities and in some cases to guarantee the continuum of care. Low-dose metronomic administration of chemotherapy with different drugs and schedules has emerged in the last years as a possible alternative to conventional chemotherapy, due to its promising tumor control rates and excellent safety profiles. Moreover, given that many metronomic schedules use the oral route administration, it could represent a therapeutic strategy to ensure continuum of cancer care during COVID 19 pandemic. In this review we have selected all the clinical studies that have used the metronomic strategy, especially with oral drugs, in order to identify the subgroups of cancer patients who can benefit most from a metronomic approach even during COVID 19 pandemic.

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