title: Beneficial effect of metronomic chemotherapy on tumor suppression and survival in a rat model of hepatocellular carcinoma with liver cirrhosis.
abstract: OBJECTIVE
  Recent studies have demonstrated that frequent, low-dose metronomic (MET) dosing of cytotoxic agents may not only be as efficient as conventional maximum tolerated dose (MTD) chemotherapy but also less toxic. In this study, we investigated the therapeutic effect and safety of MET chemotherapy using cyclophosphamide (CTX) in rats with chemically induced hepatocellular carcinoma (HCC).
  
  
  METHODS
  Rats received weekly intraperitoneal (i.p.) injections of diethylnitrosamine during 16 weeks for induction of HCC. The rats were divided into three groups: MTD group received 40 mg/kg CTX i.p. injection on days 1, 3, and 5 of a 21-day cycle; Control and MET groups received saline and 20 mg/kg CTX i.p. injection twice a week, respectively. The growth-modulating effects and overall survival were compared between the groups. Anti-angiogenic effects were evaluated by a measurement of endothelial cell and VEGFR-2 expression.
  
  
  RESULTS
  At 6 weeks of therapy, MTD and MET chemotherapy resulted in a significant reduction in tumor number and size compared with Control group. MET chemotherapy showed more prolonged survival than MTD chemotherapy and Control groups (P < 0.05). MET chemotherapy resulted in a significant decrease in both the micro-vessel density and endothelial proliferation index (P < 0.01). Furthermore, MET chemotherapy led to a greater decrease in VEGFR-2 expression at the mRNA and protein levels (P < 0.01).
  
  
  CONCLUSIONS
  MET scheduling not only exhibits anti-tumor and anti-angiogenic effects, but also prolongs survival without major toxicities in a rat model of HCC. Our results suggest that MET chemotherapy has a high therapeutic value and should be considered for future clinical trials.
authors.affiliation: Department of Internal Medicine and WHO Collaborating for Reference and Research on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.
authors.forename: Seong Tae
authors.initials: ST
authors.lastname: Park
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Gi Dae
authors.initials: GD
authors.lastname: Kim
authors.forename: Joung Ah
authors.initials: JA
authors.lastname: Park
authors.forename: Wonhee
authors.initials: W
authors.lastname: Hur
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Woo
authors.forename: Jin Dong
authors.initials: JD
authors.lastname: Kim
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Kwon
authors.forename: Chan Ran
authors.initials: CR
authors.lastname: Yoo
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
mesh_terms: D000818:Animals; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use; D017209:Apoptosis / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D049109:Cell Proliferation / Q000187:drug effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D004052:Diethylnitrosamine; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D042783:Endothelial Cells / Q000166:cytology / Q000187:drug effects / Q000378:metabolism; D015151:Immunoblotting; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000188:drug therapy*; D008114:Liver Neoplasms, Experimental / Q000139:chemically induced / Q000188:drug therapy*; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D020133:Reverse Transcriptase Polymerase Chain Reaction; D047368:Tumor Burden / Q000187:drug effects; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000235:genetics / Q000378:metabolism; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D018906:Antineoplastic Agents, Alkylating; D018809:Proliferating Cell Nuclear Antigen; D014841:von Willebrand Factor; D004052:Diethylnitrosamine; D003520:Cyclophosphamide; D040301:Vascular Endothelial Growth Factor Receptor-2