Metronomics Global Health Initiative

Metronomics in 2015

2016-01-01T13:00:27Z

Searching for “metronomic" in PubMed lead to the identification 99 publications in 2015. More publications on the topic including those using for instance the term “low dose chemotherapy” are therefore not included in this analysis.

The paediatric publications are very limited with only 7 papers published in 2015. Moreover, 4 are pre-clinical studies, one looked at angiogenic biomarkers during the maintenance of children with leukaemia and 3 are case reports.

Most of the publications deals directly with adult malignancies (68).

Interestingly, a growing part of the publications on metronomics are now clinical pieces with 41 publications in 2015. The majority are retrospective and small series (17) or case reports (7). Of note, 7 phases I, 12 phases II trials and most importantly 3 phase 3 trials have been published. Thus, Nasr and al reported that metronomic methotrexate and cyclophosphamide after carboplatin included adjuvant chemotherapy in triple negative breast cancer could lead to significant improvement in the survival and was well tolerated. (Nasr Ann Transl Med 2015). Elswhere, the Cairo 3 trials demonstrated that a Maintenance treatment with capecitabine plus bevacizumab after six cycles of CAPOX-B in patients with metastatic colorectal cancer is effective and does not compromise quality of life. (Simkens LH Lancet 2015). These phases 3 trials are important since the lack of successful phase III trials that demonstrate the usefulness of metronomic is frequently cited as a important breaks to the use of metronomic.

The lost frequently used anticancer agents in the mettronmic publication in 2015 are: cyclophosphomide (20), taxanes (10), vinorelbine (9), capecitabine/5FU (7) and temozolomide (7).

Metronomic chemotherapy is frequently used in combination with immunomodulators (8), anti-VEGF or TKI (13), drug repositioning (16) or as purely metronomic combinations (15). Among the combinations tested the combination of pazopanib and metronomic topotecan seems to have a good potential in many tumour types including paediatric malignancies.

There were also 19 reviews including 2 published in Nature Reviews Clinical Oncology.

34 publications were preclinical studies showing the sustained interested in metronomic chemotherapy from a scientific point of view with a growing interest in combining metronomic chemotherapy with immune therapies.

Metronomics

2013-01-01T15:56:00Z

While there is currently no clear definition of metronomics, it can be defined as the science associated with metronomic scheduling of anticancer treatment (MSAT), which therefore embraces both metronomic chemotherapy (MC) and drug repositioning . By combining MC and drug repositioning, metronomics allow generating innovative treatments targeting both the tumour itself and its microenvironment while maintaining low cost and minimal toxicity.

So globally : Metronomic Chemotherapy + Drug Repositioning = Metronomics

Metronomics for low income countries : the word is spreading !

2012-09-04T08:54:00Z

Slightly more than a year after the launch of the Metronomic Global Health Initiative and its website, it seems that things are moving on nicely for metronomics. Indeed, the website had over 4000 hits over its first year. Most importantly, our visitors come from all over the world. Thus, we have welcome visitors from more than 350 towns : Abidjan, Adis Abeba, Ahmedabad, Aix-en-Provence, Alges, Algiers, Almelo, Almere, Altamonte Springs, Alviso, Amman, Amritsar, Amsterdam, Ankara, Antony, Antwerp, Arras, Assen, Auckland, Aurora, Austin, Avignon, Bahia Blanca, Baku, Ballwin, Baltimore, Bamako, Bangalore, Bangkok, Bangor, Banska Bystrica, Barcelona, Bedford, Beersheba, Beijing, Beirut, Bergenfield, Berkeley, Berlin, Berne, Bethesda, Biot, Bloomfield, Bogota, Bordeaux, Boston, Bothell, Boulogne-Billancourt, Brasilia, Bratislava, Bregenz,, Bridgewater, Brighton, Brisbane, Brno, Brookline, Brugge, Brussels, Bucharest,Budapest, Buenos Aires, Burlingame, Bushey, Cairo, Calcutta, Cambridge, Caracas, Casablanca, Chandigarh, Chandler, Chapel Hill Chennai, Chicago, Chineham, Cologne, Colombes, Comayaguela, Cooksville, Copenhagen, Corpus Christi, Cumming, Dakar, Darmstadt, Davis, Decatur, Denver, Diemen, Digne, East Boston, East Hampton, East Northport, Ecublens, Eden Prairie, Edmonton, Eguilles, Elm Grove, Emeryville, Enumclaw, Evanston, Everett, Falun, Fanwood, Fes, Florence, Freiburg Im Breisgau, Fukuoka, Fuzhou, Galway, Gap, Gardanne, Geneva, Gladstone, Glendale, Gramat, Granada, Grand Rapids, Granollers, Grenoble, Groton, Guangzhou, Guelph, Hackettstown, Haifa, Hamburg, Hannover,Hartford, Hawthorne, Helsinki, Hershey, Highland Park, Highland Park,Hightstown, Holon, Honeoye Falls, Hong Kong, Honolulu, Houston, Huntington Station, Indianapolis, Irvine, Islamabad, Istanbul, Istres, Iver, Ixelles, Kansas City, Karachi, Kawagoe, Kayseri, Kiel, Kingston, Kobe, Kolhapur, Kuala Lumpur, La Garde, La Victoria, Lake Elmo, Lake Zurich, Lakewood, Lansdale, Lausanne, Lawrence, Le Blanc-Mesnil, Leiden, Leuven, Lexington, Liege, Lille, Lisbon, Lodz, London, Lorrach, Los Angeles, Lucknow, Ludhiana, Lund, Lyon, Madison, Madrid, Mahape, Makati, Malaga, Manchester, Mangaloren, Maracay, Markham, Marseille, Mbabane, Medford, Meknes, Melbourne, Memphis, Merelbeke, Merrifield, Milan, Milwaukee, Mol, Mons, Montpellier, Montreal, Mossley, Mumbai, Munich, Munster, Nairobi, Namur, Nancy, Naperville, Naples, Natick, Nazerat Illit, New Brunswick, New Delhi, New Haven, New York, Newark, Newcastle upon Tyne, Newton, Nice, Nijmegen, Nimes, North Grosvenordale, Norwich, Nottingham, Novi, Oakland, Oeiras, Olomouc, Omaha, Orleans, Oshawa, Oviedo, Oxford, Padova, Paducah, Palma de Mallorca, Palo Alto, Pamplona, Paoli, Paris, Pembroke Pines, Pennington, Perpignan, Perth, Philadelphia, Pisa, Piscataway, Playa Del Rey, Port Louis, Portland, Prague, Preston, Princeton Junction, Pune, Puyricard, Qiryat Ono, Quimper, Rabat, Red Deer, Redmond, Reutlingen, Rio de Janeiro, Rochester, Rome, Roquebrune-sur Argens, Rosario, Roubaix, San Antonio, San Francisco, San Marcos, Sandwich, Sangrur, Santa Cruz de Tenerife, Sao Joao Da Madeira, Sao Paulo, Seattle, Seneffe, Seoul, Seri Kembangan, Serris, Sevilla, Shanghai, Singapore, Solana Beach, Somerset, Somerville, Spokane, St Albans, St John's, St Louis, St Paul, St Petersburg, St-Denis, St-Eustache, St-Maur-des-Fosses, Ste-Genevieve, Stockholm, Strasbourg, Stuart, Stuttgart, Sudbury, Sukkur, Sunnyvale, Surprise, Sursee, Sydney, Tai-Nan, Taipei, Tampa, Tampere, Tarrytown, Tbilisi, Teaneck, Teddington, Tegucigalpa, Tehran, Tel Aviv, Tempe, Toledo, Tolentino, Toronto, Toulon, Toulouse, Trenton, Tucson, Utrecht, Vancouver, Vienna, Vitrolles, Warsaw, Washington, Waterloo, Watertown, Watford, Wellesley, Wembley, Westport,, Worcester, Wuhan, Yaounde, Yogyakarta, Zaporizhzhia, Zurich).
Visitors were coming from more than 60 different countries from all over the world: (Algeria, Argentina, Australia, Austria, Azerbaijan, Belgium, Brazil, Cameroon, Canada, China, Colombia, Congo, Côte d'Ivoire, Czech Republic, Denmark, Egypt, Ethiopia, Finland, France, Georgia, Germany, Honduras, Hong Kong, Hungary, India, Indonesia, Iran, Ireland, Israel, Italy, Japan, Jordan, Kenya, Lebanon, Malawi, Malaysia, Mali, Mauritius, Morocco, Netherlands, New Zealand, Pakistan, Peru, Philippines, Poland, Portugal, Réunion, Romania, Russia, Senegal, Singapore, Slovakia, South Korea, Spain, Swaziland, Sweden, Switzerland, Taiwan, Thailand, Turkey, Ukraine, United Kingdom, United States
Venezuela).
This is far beyond our inital expectations ! It seems that the metronmics approach is gaining interest worldwide. We hope to keep on raising awareness and the use about metronmics with more work. Thus, we have exciting projects with several partners that hopefully will turn into real in the coming months and more preclinical projects that shall be published in the coming months.
Laslty, MGHI welcomes everyone, every partner sharing our views....Thank you for your interest, thanks you for yours help.

Immunomodulation and antiangiogenesis in cancer using metronomic chemotherapy. New therapeutic paradigm

2012-06-16T13:37:31Z

Immunomodulation and antiangiogenesis in cancer using metronomic chemotherapy. New therapeutic paradigm

O. Graciela Scharovsky

LIX Annual Scientific Meeting of the Argentine Society of Immunology
San Miguel de Tucumán, Argentina, 19-10-2011.

The picture of the situation related to cancer treatment and the therapeutic success derived from it has significantly improved in the last half century. While the 5-year survival rate was 40% in the 60's, in 2007 it has reached 67%. Even though many a death has been avoided, lots of people continue to die because of cancer. Such a reality permanently fuels the search for new treatments which, at present, are asked to be not only therapeutically successful but also to provide the patient a good quality of life. Following this line of thinking, and working experimentally, we began to investigate the effect of a single-low dose of cyclophosphamide (Cy) on metastasis development of a rat B-cell lymphoma. We demonstrated the antimetastatic effect of the treatment as well as its lack of toxicity. The modulation of the host immune response would be responsible for such effect, since the treatment induced a change in the cytokines profile from Th2 to Th1, an increase in lymphocyte proliferation, a decrease in Galectin-1 expression by the tumor, a decrease in circulating Tregs and also a negative regulation of IL-10 production and IL-10 receptor expression in cells with metastatic phenotype. With those results we developed a hypothetical model of the modifications produced during tumor progression and the effect on them caused by a single-low dose of Cy. Then, with the objective of obtaining a therapeutic effect on the primary tumor, we designed treatments in which we repeated the Cy low doses administering them at regular intervals, without extended rest periods. Thus, we entered in the field of metronomic chemotherapy (MCT), a therapeutic philosophy that differs from that presently accepted of the maximum tolerated dose. In the MCT treatment modality the main cell targets are the tumor endothelial cells, the modifications of which would be responsible, at least in part, for the therapeutic effect. We utilized several tumor models as lymphoma, sarcoma, and mammary adenocarcinomas and we could demonstrate the antitumor and antimetastatic effect of MCT with Cy as a monotherapy or, even better, combined with Celecoxib (Cel), a COX-2 inhibitor, increasing the survival of tumor-bearing animals. Generally speaking, this therapeutic modality was devoid of overall cardiac, hematologic, hepatic and renal toxicity. Interestingly, tumor angiogenesis inhibition, along with modulation of the immune response of treated animals, accounted for the observed therapeutic effects. The pre-clinical results obtained, and the incipient clinical experience in MCT protocols with different therapeutic schemes or different types of tumors, carried out by other research groups, led us to design and develop a Phase I/II trial for the treatment of advanced breast cancer patients with MCT with Cy + Cel. The project was approved by the School of Medical Sciences Bioethics Committee and by A.N.M.A.T. (the Argentine Regulatory Agency) and it is now under way, with the first out of two stages, completed. So far, the results obtained are encouraging and have allowed us to proceed with the second stage. Thus, these results, together with those coming from other laboratories, tend to build a stronger case for a paradigm change in the field of cancer therapeutics in which “more is not better” and “less is more if administered chronically”.

Metronomic chemotherapy : publications on the rise !

2012-02-11T16:52:48Z

We have just analyzed the number and type of publications about metronomic chemotherapy indexed in the Thomson Reuters Web of Knowledge database from 2000 to 2011. 2000 was the year of the 2 first pre-clinical papers form the team of Judah Folkman and Robert Kerbel reporting about the potential of low dose anti-angiogenic chemotherapy were published. Following these 2 papers, Douglas Hanaghan introduced the term metronomic the very same year.
We searched in the Thomson Reuters Web of Knowledge database all articles using the key word "metronomic". All non-relevant articles (outside of the field of oncology) and abstracts from conferences and/or meeting were excluded. Then, articles were classified as review, editorial, letter to the editor, preclinical work or clinical work. It is important to note that articles using the term “low doses” or “oral” that were commonly used for etoposide or cyclophosphamide are therefore not included in the analysis. Similarly all the literature about maintenance therapy for leukemia that relies on metronomic purinethol and methotrexate is absent.
Overall, we identified 593 publications from 2000 to 2011. Details about the number and type of publications can be found in the figure 1.
There is a clear increase in the number of publication since 2000 with a total number of publications per year ranging from 4 in 2000 to 102 in 2010.

There is an important number of reviews which constitute almost 20% of the metronomic publications. Preclinical and clinical studies represent each roughly 30% of the publications.
The percentage of paediatric publication is rather limited with 8% of the total. Among these, half of the publications are clinical studies or cases report. There are only 8 preclinical work dedicated to the filed of paediatric.

Of note, within 11 years there are only 3 publications that deal with metronomic chemotherapy in developing countries. One of these publications is the Metro-Mali01 by Fousseyni Traore and the second an editorial that accompanied the publication of MetroMali. Hopefully, the number of papers reporting the use of metronomic in low or middle income countries, may increase since in 2012, there are already two publications from the Tata Memorial Institute in Mumbay.

– Klement, G, et al. Continuous low-dose therapy with vinblastine and VEGF receptor-2 antibody induces sustained tumor regression without overt toxicity. J Clin Invest 2000. 105:R15-R24
– Browder, T, et al. Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res 2000. 60:1878-1886.
– Hanahan, D, and al. Less is more, regularly: metronomic dosing of cytotoxic drugs can target tumor angiogenesis in mice J Clin Invest. 2000;105:1045–1047
– Fousseyni, T et al. Children treated with metronomic chemotherapy in a low-income country: METRO-MALI-01. J Pediat Hemato Oncol 2011 ; 33 : 31-34
– Klement, GL, et al. Nontoxic, Fiscally Responsible, Future of Oncology: Could it be Beginning in the Third World? J Pediatr Hematol Oncol. 2011; 33:1-3.
– Sondhi, V, et al. Complete Remission and Long-term Survival in a Child With Relapsed Medulloblastoma With Extensive Osteosclerotic Bony Metastasis With a Novel Metronomic Chemobiological Approach. J Pediatr Hematol Oncol. 2012 Jan 16. [Epub ahead of print]
– Patil V, et al. Metronomic chemotherapy in advanced oral cancers J Can Res Ther 2012;8:106-10

Metronomics Global Health Initiative : Ensemble pour le développement de nouvelles stratégies anticancéreuses durables pour les enfants des pays en voie de développement.

2011-12-19T11:18:00Z

La Metronomics Global Health Initiative combine recherche médicale de pointe, nouveaux modèles économiques et innovation sociale pour développer de nouvelles stratégies anticancéreuses pour les enfants atteints de cancer dans les pays pauvres.

Nous avons besoins de nouveaux modèles pour satisfaire les besoins en santé des plus démunis de la planète. En effet, aujourd'hui, 90% du marché de la santé concerne seulement les besoins de 15% des plus riches.
Plus spécifiquement, 80% des enfants vivent dans des pays en voies de development et plus de 200.000 d'entre eux développent, chaque année, un cancer. Ces enfants n'ont qu'un accès très limité aux soins et aux traitements curateurs. Aussi, 25% seulement vont survivre alors que plus de 75% des 50.000 enfants diagnostiqués avec un cancer dans les pays industrialisés guérissent de leur maladie.
Plusieurs problèmes empêchent la mise en place de stratégies anticancéreuses efficaces dans les pays en voies de développement : disponibilité des médicaments et des structures de soins, cout et toxicités de la chimiothérapie, distance par rapport aux unités d'oncologie pédiatrique, compliance avec les traitements, retard du diagnostic, consultations avec des médecins traditionnels et barrières culturelles.
Il est donc indispensable de mettre en place des stratégies réalistes qui prennent en compte ces contraintes.
La stratégie que nous voulons valider repose sur 2 principes :
1) l'utilisation des médicaments de chimiothérapie « standards » administrés différemment c'est-à-dire avec à des petites doses fréquentes et par voie orale et changer ainsi leur mécanisme d'action. Cette approche s'appelle la chimiothérapie métronomique.
2) l'utilisation de médicaments non anticancéreux et donc moins toxiques que la chimiothérapie coventionelle pour lesquels on découvre des propriétés anticancéreuses novatrices : cette approche s'appelle le « drug repositioning ».
Au final, la combinaison des deux approches permet de générer des traitements anticancéreux à la fois peu couteux, peu toxique, facile à administrer particulièrement adapté aux pays en voie de développement.

Néanmoins, les médicaments anticancéreux anciens rapportent peu d'argent en comparaison aux nouveaux agents anticancéreux modernes qui peuvent couter jusqu'à 1000 fois plus cher. De plus, les cancers des enfants sont des maladies orphelines. Repésentant un marché très petit, elles ne sont pas rentables.
Ainsi, grâce à la mise en place de supports mixtes caritatif et institutionnel, le development de protocoles thérapeutiques reposant sur la stratégie métronomique est possible ; en donnant des moyens aux médecins et structures locales par une aproche dite « bottom of the pyramid » .
Nous voulons être les pionniers de stratégies, innovantes, durables et adaptées pour lutter contre les cancers des enfants vivants dans les pays en voie de développement. Nous voulons être le lien entre les citoyens, les médecins, les sociétés savantes, les associations non gouvernementales, l'institution académique, les compagnies pharmaceutiques et les gouvernements pour favoriser l'émergence de ces traitements.
Dans la première phase du projet, nous voulons démontrer l'efficacité de la chimiothérapie dans un tel contexte. Aussi, nous voulons lancer plusieurs études cliniques, qui permettront d'établir la validité de cette approche pour traiter le cancer dans les pays en voie de développement.
Nous n'accepterons aucun compromis sur la rigueur scientifique ou éthique pour mener à bien nos objectifs.
Un site internet a été crée pour expliquer notre démarche (www.metronomics.newethical.org), nos projets, nos réalisation et pour rassembler les personnes qui voudront être des chercheurs, des ambassadeurs, des supporters pour avancer à nos cotés. Tous les individus qui partagent nos visions, nos ambitions pour transformer notre monde sont les bienvenus.
Nous accueillons toutes les institutions qui veulent promouvoir l'innovation sociale et/ou scientifique qui veulent œuvrer à long terme pour le développement de stratégies innovantes, durables et adaptées pour pour lutter contre le cancer des enfants des pays en voies de développement.

全球健康行动倡议

2011-11-11T16:53:18Z

全球健康行动协会将顶尖的科学技术、新型商业模式和新的社会理念结合在一起，用以研发多种癌症治疗方法，并向发展中国家儿童提供治疗。

我们需要新型的商业模式以满足世界上最贫穷人群的健康需求：如今，90%的市场为15%的最富有人群提供服务。

另一方面，世界上80%的儿童生活在发展中国家，而每年约有20万发展中国家儿童被诊断出患有癌症。这些儿童所能够获得的治疗条件是非常有限的，他们中大约仅有25% 最终可以存活（在高收入国家中，每年有5万儿童被诊断患有癌症，但其中75% 的儿童最终可以存活）。

很多因素阻碍着发展中国家拥有其有效的癌症治疗手段。例如：无法获取有效的抗癌药物以及医疗设备、医疗经费不足和毒性治疗、缺少儿科肿瘤医治的专业人士、无治疗资质、延误诊断、优先服从传统手段以及文化障碍。因而，必须为在这些发展中国家中正遭受癌症病痛折磨的儿童寻找一种可行的并且将会被采用的医疗方法。

专业医疗机构向我们提供了一种混合疗法，这种疗法既低价且可以做到无毒治疗。这项新型研究成果可以大大减少费用开支，并且已经获得医师的许可。因此，我们希望成为这项技术的领军推行者，并帮助发展中国家的儿童抗击癌症。

这些治疗手法需要：一、经常低剂量口服原先的抗癌药物（定期化疗）；二、若是癌症性质显现（药物产生抗药性），则服用原先的非抗癌药物。这些治疗方法将使得治疗变得无毒、低价，使得病情易控制，也使得对于癌症病人的治疗在这些发展中国家中比较容易得到掌控。

我们的长期目标就是通过在医生、医疗协会、保健公司、政府、国际医疗机构和相关市民之间建立广大的关系网，互相协作，在发展中国家推行这种癌症治疗方法。

我们相信，也敢于相信，发展中国家的医疗推广一定会实现，并且将尽早实现。

此次项目的第一阶段，我们希望明确这些治疗手段在哪些情况下将会有效。为了达到这个目标，我们会将我们一直以来的热情投入到为这项尖端科学提供的服务中。我们希望提出一系列的尖端临床研究成果，以明确确定在哪些情况下，这些技术可以适用以治疗癌症。我们绝不会在严肃的、客观的和谨慎的科学面前有点滴马虎。

我们希望能够通过这个网站和发布这次行动，创建一个团队，这个团队将作为先锋队着手为这个项目的未来开辟一条道路。我们欢迎那些受过良好教育，对我们项目有兴趣，并且希望通过这个项目看到世界改变的个人来加入我们。我们同时也欢迎那些支持社会事业、医疗事业和商业模式发展的机构加入进来，共同为帮助发展中国家儿童抗击癌症出份力。

Reflections from an Expert about Communicating the Initiative

Marc Le Menestrel — 2011-06-14T20:23:18Z

These are notes from a discussion with Katie, a communication expert in the field of Global Health. They show first positive reactions and potentially fruitful ideas to communicate our initiative.

Maternal and Child Health (Millenium Development Goals 4 and 5) will be the next big investment on Global Health.

Cancer is very well understood in developed countries. Thus, social networks could be harnessed to get support for the initiative

Cancer is congruent with a grass-root community support, in part because every one knows a family member who has cancer.

Local or national manufacturers in developing countries, who have had a hard time to compete against international pharma, may lobby national governments not to support an initiative that make cheaper drugs available.

There are experiences from which we can learn, for instance the Affordable Medicine Facility (Malaria) AMFM supported by the Global Fund and all major malaria players.

Drug Repositioning

Nicolas André — 2011-06-10T09:01:09Z

A model of sustainable drug development: recycling old drugs to turn them into long term anti-cancer targeted therapies

Drug repositioning consists in using old drugs for new indications. The theoretical and pragmatic advantages to testing already established drugs for a potential effect on cancer cells are clear. The side-effects are known and have already been well documented. Phase I are not mandatory so that, those drugs can immediately enter phase II studies to test their efficacy for cancer treatment. One of the main efforts of drug repositioning relies in identifying the right new therapeutic areas to prospectively test for a given drug. Some examples are available in the field of cancer with drugs such as celecoxib, valproic acid, statins, or more recently propranolol or nifurtimox. Interestingly these agents display new mechanisms of action that can be found in expensive new developed agents !

Traditionally, anticancer treatments were based on the use of anticancer agents administered at their Maximal Tolerated Dose (MTD) given every 3 weeks. Recently, the concept of metronomic scheduling proposed that low frequent dose of anticancer agents could be an alternative strategy to spaced-out MTD. This kind of scheduled has been largely adopted for the so called targeted therapy and is being increasingly used with old anticancer drugs such as etoposide, cyclophosphamide or anti-tubulin agents. Metronomic scheduling makes it possible for almost any drug given on a daily basis (usually orally) to turn into an anticancer agent.

Repositioned drugs because of their well know and well established low toxicities, their low cost and their new mechanism of action allows low income countries to innovate to built the treatments their people with cancer need at low cost.

Metronomics Global Health Initiative

2011-06-06T16:14:26Z

After 10 years of research and clinical practice in the field of metronomic chemotherapy, Metronomic Global Health Inititiative was founded by Nicolas ANDRE with the persuasive help of Marc Le Menestrel and the support of Eddy PASQUIER

Indeed, convinced that thanks to its low toxicities, its low cost, its easy accessibility, and the infinite potential of innovation associated with drug repositioning, metronomic chemotherapy was an important strategy to help fighting cancer in developing countries, we pionneered its use in Mali.

We then imaginated Metronomics-Global-Health–Initiative as the structure that could promote the development of metronomics with the highest standards and pave the way for new global strategies to fight cancer in developing countries.

The Metronomics-Global-Health–Initiative aims to :

1) demonstrate that metronomic approach can lead to improve the lives of children with cancer in developing countries and establish it as "a standard of cancer" in some situations. Beyond the metronomic treatments, this approach brings a novel view on cancer disease and cancer cares.

2) gather funding to develop or help developing projects based on metronomic approach to fight cancer in children living in developing countries

3) facilitate cross-sectors partnership we can bring to life projects that will revolutionize management of cancer in low income countries and maybe in turn in industrialized cancer.

4) establish Metronomics-Global-Health–Initiative as a major partner in developing new strategies to fight cancer

Although our main focus, is children suffering from in developing countries, we will also develop and facilitate new projects concerning metronomic treatments in adults and in industrialized countries.