title: Metronomic therapy can increase quality of life during paediatric palliative cancer care, but careful patient selection is essential.
abstract: OBJECTIVE
  Children with refractory or high-risk malignancies frequently suffer from poor quality of life during palliative care. This study explored the effect of metronomic drug administration on survival and quality of life in paediatric patients with various refractory or high-risk tumours.
  
  
  METHODS
  We treated 17 patients with a maintenance therapy that consisted of metronomic thalidomide, etoposide and celecoxib. The endpoints of the study were overall and progression-free survival, changes in the Karnofsky-Lansky scores from baseline to the end of the study therapy and radiological responses.
  
  
  RESULTS
  The median overall survival after the start of the study therapy was 6.2 months (range 2.0-57.7), and the six-, 12- and 24-month survival rates were 59%, 18% and 18%, respectively. The median progression-free survival was 3.2 months (range 0.3-17.8). The Karnofsky-Lansky scores increased significantly during the study therapy (p = 0.02), with 35% of the patients having a transient improvement in their clinical status. Radiologically, one partial response and two disease stabilisations were encountered. Grade III-V adverse events occurred in 76% of the patients.
  
  
  CONCLUSIONS
  Metronomic therapy may increase the quality of life during palliative care for childhood cancer, but requires careful patient selection to minimise the risk of serious adverse events.
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Mikaela
authors.initials: M
authors.lastname: Porkholm
authors.affiliation: Department of Pediatric Radiology, Helsinki Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Sanna
authors.initials: S
authors.lastname: Toiviainen-Salo
authors.affiliation: Department of Pediatric Radiology, Helsinki Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Raija
authors.initials: R
authors.lastname: Seuri
authors.affiliation: Division of Child Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Lönnqvist
authors.affiliation: Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Kaisa
authors.initials: K
authors.lastname: Vepsäläinen
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ulla M
authors.initials: UM
authors.lastname: Saarinen-Pihkala
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Virve
authors.initials: V
authors.lastname: Pentikäinen
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Sanna-Maria
authors.initials: SM
authors.lastname: Kivivuori
mesh_terms: D059250:Administration, Metronomic; D002648:Child; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D010166:Palliative Care; D018579:Patient Selection; D011446:Prospective Studies; D011788:Quality of Life
keywords: Celecoxib; Etoposide; Metronomics; Paediatric; Thalidomide