Metronomic chemotherapy in cancer: A ray of hope

Abstract

Background: Despite the high incidence of cancer and its related mortality, our knowledge regarding optimal treatment is limited necessitating the researchers to find an alternate therapy. Metronomic chemotherapy (MCT) is the potential new modality for cancer therapy. A dearth of studies on MCT has encouraged us to conduct a systematic review to observe the clinical trials conducted globally using MCT for various types of cancer. The primary objective was to assess the utilization of MCT in various cancers and drug regimens utilized. The secondary objective was to evaluate the objective, study design, patient demographics, country, and the outcome of the study. Materials and Methods: A literature search extracted the clinical trials using MCT from two electronic databases PubMed and clinicaltrial.Gov with an appropriate search term. Included articles were analyzed using descriptive statistics. Results: Two hundred and forty-five out of two hundred and eighty-seven articles retrieved met the inclusion criteria. The most studied cancers were breast (26.1%) and central nervous system (13.9%). Cyclophosphamide (46.1%) and capecitabine (18.8%) were the frequently used chemotherapeutic drugs. The rationale for drug selection was antiangiogenesis mostly (47.3%). Most of the studies were phase II clinical trials (56.3%). About 23.7% of trials were conducted in the United States of America, and 38.8% of the trials were carried out in a multicentric setup. Majority trials had tumor assessment as its endpoints (49.4%), and 35.1% of trials had open-label and nonrandomization methods. Conclusion: MCT was used commonly in breast cancer with cyclophosphamide and capecitabine being frequently used drug and tumor assessment being the most frequent endpoint utilized. MCT was employed due to its antiangiogenic properties in majority of the trials. Phase II and nonrandomized, single-arm, and open-labeled studies were the most observed study design.