title: Long-term complete response in a patient with liver metastases from breast cancer treated with metronomic chemotherapy.
abstract: BACKGROUND
  Preclinical studies have shown that several chemotherapeutic agents at low doses may affect the vascular system. Here we report the case of a patient with long-term cancer control by metronomic chemotherapy.
  
  
  METHODS
  A 62-year-old woman with breast cancer underwent a left mastectomy in July 2007. For a liver metastasis she was given first-line chemotherapy with doxorubicin plus paclitaxel every 21 days. A CT scan after the sixth cycle showed a partial response. It was decided to stop the treatment with doxorubicin and paclitaxel, and start metronomic therapy with cyclophosphamide 50 mg daily orally and methotrexate 2.5 mg twice daily, 2 days a week. After 6 months of this maintenance treatment, CT scan showed a complete response. We examined the expression of vascular endothelial growth factor receptor 2 (VEGFR2) in histological sections of the primary tumor of our patient, finding evidence of overexpression of the receptor. The metronomic treatment is still ongoing, and after 60 months the patient maintains a complete response.
  
  
  CONCLUSIONS
  This clinical case highlights how suitable metronomic chemotherapy can be used as maintenance therapy, allowing long-term treatment with no significant toxicity. This case suggests that the level of VEGFR2 is predictive of best response to antiangiogenic therapy.
authors: Lorenzo
authors: L
authors: Cecconetto
authors: Andrea
authors: A
authors: Casadei Gardini
authors: Elena
authors: E
authors: Tenti
authors: Roberta
authors: R
authors: Maltoni
authors: Sara
authors: S
authors: Bravaccini
authors: Devil
authors: D
authors: Oboldi
authors: Wainer
authors: W
authors: Zoli
authors: Patrizia
authors: P
authors: Serra
authors: Caterina
authors: C
authors: Donati
authors: Samanta
authors: S
authors: Sarti
authors: Dino
authors: D
authors: Amadori
authors: Andrea
authors: A
authors: Rocca
mesh_terms: D059250:Administration, Metronomic; D000284:Administration, Oral; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000556:secondary; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000556:secondary*; D060046:Maintenance Chemotherapy; D015411:Mastectomy, Modified Radical; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D015854:Up-Regulation; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D004317:Doxorubicin; D003520:Cyclophosphamide; C000588866:KDR protein, human; D040301:Vascular Endothelial Growth Factor Receptor-2; D017239:Paclitaxel; D008727:Methotrexate