We are delighted to provide the report form the 4th metronomic meeting which took place’ in Milano last June. The report entitled Lessons from the Fourth Metronomic and Anti-angiogenic Therapy Meeting has been written by Gauthier Bouche from the Anticancer Fund, with several members of the Metronomics Global Health Initiative as coauthors. The report has been published on the Ecancer journal and noteworthy the costs associated with publishing this article have been covered by charity funding. This journal is in open acces so that you can acces freely the full text of the paper by clicking here. Is is also attached to this post.

Abstract

Gauthier Bouche, Nicolas André, Shripad Banavali, Frank Berthold, Alfredo Berruti, Guido Bocci, Giovanni Brandi, Ugo Cavallaro, Saviero Cinieri, Marco Colleoni, Giuseppe Curigliano, Teresa Di Desidero, Alexandru Eniu, Nicola Fazio, Robert Kerbel, Lisa Hutchinson, Urszula Ledzewicz, Elisabetta Munzone, Eddy Pasquier, O Graciela Scharovsky, Yuval Shaked, Jaroslav Štěrba, Martin Villalba and Francesco Bertolini

The Fourth Metronomic and Anti-angiogenic Therapy Meeting was held in Milan 24–25 June 2014. The meeting was a true translational meeting where researchers and clinicians shared their results, experiences, and insights in order to continue gathering useful evidence on metronomic approaches. Several speakers emphasised that exact mechanisms of action, best timing, and optimal dosage are still not well understood and that the field would learn a lot from ancillary studies performed during the clinical trials of metronomic chemotherapies. From the pre-clinical side, new research findings indicate additional possible mechanisms of actions of metronomic schedule on the immune and blood vessel compartments of the tumour micro-environment. New clinical results of metronomic chemotherapy were presented in particular in paediatric cancers [especially neuroblastoma and central nervous system (CNS) tumours], in angiosarcoma (together with beta-blockers), in hepatocellular carcinoma, in prostate cancer, and in breast cancer. The use of repurposed drugs such as metformin, celecoxib, or valproic acid in the metronomic regimen was reported and highlighted the potential of other candidate drugs to be repurposed. The clinical experiences from low- and middle-income countries with affordable regimens gave very encouraging results which will allow more patients to be effectively treated in economies where new drugs are not accessible. Looking at the impact of metronomic approaches that have been shown to be effective, it was admitted that those approaches were rarely used in clinical practice, in part because of the absence of commercial interest for companies. However, performing well-designed clinical trials of metronomic and repurposing approaches demonstrating substantial improvement, especially in populations with the greatest unmet needs, may be an easier solution than addressing the financial issue. Metronomics should always be seen as a chance to come up with new innovative affordable approaches and not as a cheap rescue strategy.