Metronomics Global Health Initiative

Metronomic chemotherapy in pediatric neuroblastoma

Nicolas André — 2024-11-29T08:33:00Z

A review about metronomic chemotherapy and neuroblastoma written by Yi Jiang, Chengjun Xi, Chao Yang from the Children's Hospital of Chongqing Medical University, Chongqing, China
The review is entitled : Metronomic chemotherapy in pediatric neuroblastoma and has been published in Pediatric Discovery.

The full text is freely available here

Abstract

Metronomic chemotherapy (MC) is an innovative therapeutic approach that involves the chronic administration of low doses of chemotherapy agents. This strategy aims to sustain prolonged and active plasma levels of drugs, which can result in favorable tolerability. MC has shown promise in the treatment of hematologic and solid tumors, including high‐risk neuroblastoma and relapsed/refractory (R/R) neuroblastoma. In the contemporary management of neuroblastoma, MC stands as a viable maintenance therapy for newly diagnosed patients lacking access to autologous stem cell transplantation or immunotherapy, particularly in resource‐constrained regions. Furthermore, it serves as a pragmatic alternative for individuals intolerant to intensified regimens or undergoing palliative care for R/R neuroblastoma. Nevertheless, the quest for the optimal MC regimen persists, necessitating comprehensive investigations to delineate standardized protocols. Moreover, the identification of potential biomarkers or prognostic indicators assumes paramount significance in refining MC strategies for future breakthroughs in this domain. This review embarks on a comprehensive exploration of MC in neuroblastoma, offering insights into its historical underpinnings, diverse applications, adverse effect and future prospects, endeavoring to enrich our understanding of MC role in neuroblastoma management.

Slow and Steady Keeps Them in the Race: Metronomic Therapy in Children With Cancer

2020-06-16T17:14:20Z

An editorial entitled : Slow and Steady Keeps Them in the Race: Metronomic Therapy in Children With Cancer by SIDHARTH TOTADRI from the Pediatric Hematology-Oncology Unit, Department of Pediatrics, Christian Medical College and Hospital, Vellore, India has just been published in Indian Pediatrics.

It highlights the recent ancillary associated pediatric trial published in Jama Oncololgy (Pramanik R et al. Metronomic chemotherapy vs best supportive care in progressive pediatric solid malignant tumors: A randomized clinical trial. JAMA Oncol. 2017;3:1222-7.

In this ancillary study, no angiogenic biomarkers were identified but an decrease in TPS1 was observed in responders and an increase in non responders; confirming the role of angiognenesis on the anticancer effect of metronomic chemotherapy.

You can acces free full text here.

ETHealth Wordl interview of Dr. Nicolas Andre : The field of metronomics in cancer is moving towards precision medicine

2016-10-08T12:50:32Z

People are getting used to the ideal of using metronomic chemotherapy and drug repositioning to treat refractory disease.

Dr. Nicolas Andre, Pediatric Oncologist, Hospital Pour Enfants De La Timone Marseille, France, talks to ETHealthworld about the latest finding from researches and clinical trials in metronomic chemotherapy.

Edited excerpts:

What is Metronomics Global Health Initiative?

Metronomics Global Health Initiative is something that we launched four years ago. We are working on metronomic chemotherapy with a view that this kind of treatment could be really useful for cancer patient living in low and middle income countries. When you live in a poor country you don't have a dedicated infrastructure, you may live far way from a cancer centre, you may not have a healthcare coverage or be poorly nourished due to which you may not be able to tolerate the treatment, so for all these reasons metronomic chemotherapy seems to fit well. We launched the website to put information about clinical trials, about the scientific data that would be available and we started to build the network of clinicians, people and institutions that would share the view about the potential of this treatment. We also do some pre-clinical research; we help setting clinical trials and organizing meetings for promoting this approach.

Tell us about the clinical trials and researches that you have undertaken?

We have been able to generate some knowledge and identify some new drugs. We work on metronomic chemotherapy but also drug repositioning – which involves using drugs that were not designed to be anticancer agents but do have anticancer properties. We have worked a lot on propenol and showed that it could work on some pediatric and adult cancers. So now we are moving to the clinical trials.

In France we currently have three metronomic trials going on and one has just stopped. We at this stage are validating activity on soft combinations and are trying to demonstrate new combinations that are based on pure drug repositioning. People are getting used to the ideal of using metronomic chemotherapy and drug repositioning to treat refractory disease.

How is this helping patients in low and middle income countries?

In low and middle income countries we published two trails about metronomic chemotherapy for children in Mali. It was successful as we managed to develop protocols that could be given to patients where disease would either relapse, which didn't have any potential treatment otherwise and also to patients who come to the hospital with too advanced disease. So we would not tolerate toxic chemotherapy. We generated this alternative and now it is used on daily basis in the centre.

How do you see the future of cancer treatment?

The field of cancer is moving towards precision medicine and that is one of the drawbacks of metronomic chemotherapy. We don't really know how it works in a given patient. I guess metronomic chemotherapy is going to be combined with the new sophisticated treatment and it is a good candidate as it has an activity of its own and its non toxic so it can match well with targeted therapy