Metronomic Therapy for Metastatic Breast Cancer: A Preliminary Report

Abstract

Objectives: ”Metronomic Therapy” was suggested by Kerbel et al. and is becoming a newly applied regimen for cancer patients where low doses of chemotherapeutics at a high frequency are used for long term treatment. This study aims to measure the effectiveness of combining an initial traditional maximum tolerated dose regimen with a metronomic agent as consolidating therapy. Methods: From 2004 February to 2004 December, six female patients with an average age of 49 years were enrolled in this pilot study. All the patients were histologically identified as having metastatic breast cancer (MBC) and received oral Tegafur/Uracil (UFUR(superscript TM)) 400mg per day as the consolidating agent until tumor progression after they had initially received maximum tolerated dose chemotherapies of DEC (Docetaxel 75 mg/m2, Epirubicin 75 mg/m2, Cyclophosphamide 500 mg/m2) or BE (Docetaxel 75 mg/m2, Epirubicin 75 mg/m2) regimens for four to six maximum cycles. Patients with Her2/neu positive were also treated by Trastuzumab before initiating the Tagafur/Uracil treatment schedule. The diagnosis of response was made according to CT, PET scans and Sonography every two months. We aimed to see the prolongation in time to treatment progression (TTP). Results: By April 2006, the median follow up time for the six patients was 19 months. One of the patients had progressed (lung metastasis) after 5 months and the others were still receiving oral Tegafur/Uracil treatment. Two of the patients reached partial response and other three patients remained in stable disease. The overall response rate was 2/6 (33%) and clinical benefits including overall response and stable disease was 5/6 (83%) with a median time to treatment progression of more than 16 months without severe hematological or non-hematological side effects. Conclusion: Oral Tegafur/Uracil 400mg/day seemed to be effective as a metronomic consolidating agent, and it would seem that this approach can significantly prolong TTP when treating MBC and with very low toxicity.