Following our[ Lancet Oncology] paper, metronomics is gaining interest in India where journals like The Economic Time and Times of India have recently highlighted the potential of metronomics !

Here are some examples:

Cancer medicines for as low as Rs 1,000 a month on way !

MUMBAI: It’s widely known that a month’s dose of cancer drugs can cost lakhs, but what isn’t common knowledge is that Tata Memorial Hospital’s doctors are working on alternatives that could cost less than Rs 1,000 a month. Dubbed the metronomic treatment protocol, it comprises daily consumption of a combination of low-dose medicines that are cheap because they have been around for decades. "Thereis no need to worry about patents or recovery of billions spent on research ," said Dr Shripad Banavali, head of the medical oncology department of Tata Memorial Hospital, Parel, who has been working on the low-dose, low-cost therapies. "The metronomics experiment is path-breaking in terms of providing good quality and affordable cancer care for a majority of the over 10 lakh cancer cases diagnosed in India each year," said his colleague Dr Surendra Shastri. These findings could revolutionize cancer care in developing countries, he added. The catch is this branch is still in research stage. In metronomic therapies, the drugs are given at very low doses. "But side-effects are fewer and patientshave a good quality of life,’’ said Banavali. In it, affordable and well-known drugs are repositioned as cancer killers For instance, anti-diabetic drug metformin for aggressive breast cancer Anti-seizure drug sodium valproate against acute myeloid leukemia Anti-hypertensive drug propranolol against angiosarcoma (cancer of blood vessels)

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MUMBAI: It’s widely known that a month’s dose of cancer drugs can cost lakhs, but what isn’t common knowledge is that Tata Memorial Hospital’s doctors are working on alternatives that could cost less than Rs 1,000 a month.

Dubbed the metronomic treatment protocol, it comprises daily consumption of a combination of low-dose medicines that are cheap because they have been around for decades. "There is no need to worry about patents or recovery of billions spent on research,’’ said Dr Shripad Banavali, head of the medical oncology department of Tata Memorial Hospital, Parel, who has been working on the low-dose-low-cost therapies.

His colleague, Dr Surendra Shastri sums up the mood well: "The metronomics experiment is path-breaking in terms of providing good quality and affordable cancer care for a majority of the over 10 lakh cancer cases diagnosed in India each year.’’ These findings could revolutionize cancer care in most developing countries, he said.

The catch is, however, that this branch is still in research stage. The conventional cancer treatment comprising chemotherapy is given at "maximum tolerated doses" which are tested and have reams of research to back it. As against this, in metronomic therapies, the drugs are given at very low doses. "But side-effects are fewer and patients have a good quality of life,’’ said Dr Banavali.

The word metronomics is borrowed from music; musicians use the metronome to mark time and hence rhythm. Patients are asked to take these medicines for a period of 21 days or more before taking a break of a week; such a cycle continues for months.

Dr Banavali’s work has been published in the May issue of the medical journal Lancet Oncology. Thousands of patients have been on metronomic treatment in Tata Memorial Hospital as well as its rural centre, with a sizeable number managing to control the growth of cancer. "In India, the main challenge in cancer is not just finding cures, but to develop affordable treatments’’ he said.

In fact, the metronomic work arose out of such cost concerns over a decade back. The Tata doctors found that many patients were lost to treatment because they were overwhelmed by the cost of medicines. "Moreover, many patients came so late for treatment that we had to turn them away without any medicines,’’ said Dr Banavali. Instead of turning away such patients, the Tata team decided to adopt the metronomic treatment as palliative treatment that was being tested out in various parts of the world. "We gave them drugs that would help in pain or at least ensure that their case doesn’t worsen," he adds.

But the results surprised them. In a large group of children with blood cancers called acute myeloid leukemia (AML), they found that metronomic maintenance treatment had helped increased survival rate to 67%. The group then started its own innovation, going ahead of the rest of the world. "The West used the same set of medicines for all forms of cancer, but we introduced personalised medicines for various types of cancers,’’ said Dr Banavali.

The Lancet paper, titled ’Has the time come for metronomics in low-income and middle-income countries’, mentions combination of drugs used for four cancers (see box). The Tata doctors feel that these drugs may work as well for newly developed tumours. "While the developed world is going after ’drug discoveries’, that is discovering new drugs which are very costly for our patients, we are going after ’drug repositioning’, that is using time-tested drugs for the treatment of cancer," said Dr Banavali. For example they are using drugs like metformin (an anti-diabetic drug), sodium valproate (an anti-seizure drug) and propranolol (an anti-hypertensive drug) in the treatment of cancer.

The Lancet paper said, "The combination of metronomic chemotherapy and drug repositioning might provide a way to overcome some of the major constraints associated with cancer treatment in developing countries and might represent a promising alternative strategy for patients with cancer living in low- and middle-income countries.’’

Metronomics chemotherapy works at three levels. It attacks tumours while working on the "micro-environment", like the blood vessels, around the tumour. Thirdly, it works on the immuno-modulating system of the body. "Unless the metronomic dose works on all these three fields, it may not work,’’ said the doctor.