title: Metronomic chemotherapy: A relook at its basis and rationale.
abstract: Metronomic administration of chemotherapy has long been recognized as having a different biological effect from maximal tolerated dose (MTD) administration. Preclinical studies have demonstrated these differences quite elegantly and many clinical trials have also demonstrated reproducible activity albeit small, in varied solid malignancies even in patients who were heavily pretreated. However, the concept of metronomic chemotherapy has been plagued by lack of a clear definition resulting in the published literature that is rather varied and confusing. There is a need for a definition that is mechanism(s)-based allowing metronomics to be distinguished from standard MTD concept. With significant advances made in understanding cancer biology and biotechnology, it is now possible to attain that goal. What is needed is both a concerted effort and adequate funding to work towards it. This is the only way for the oncology community to determine how metronomic chemotherapy fits in the overall cancer management schema.
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore. Electronic address: tanujaa.rajasekaran@singhealth.com.sg.
authors.forename: Tanujaa
authors.initials: T
authors.lastname: Rajasekaran
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore. Electronic address: ng.quan.sing@singhealth.com.sg.
authors.forename: Quan-Sing
authors.initials: QS
authors.lastname: Ng
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore. Electronic address: daniel.tan.s.w@singhealth.com.sg.
authors.forename: Daniel Shao-Weng
authors.initials: DS
authors.lastname: Tan
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore. Electronic address: darren.lim.w.t@singhealth.com.sg.
authors.forename: Wan-Teck
authors.initials: WT
authors.lastname: Lim
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore. Electronic address: ang.mei.kim@singhealth.com.sg.
authors.forename: Mei-Kim
authors.initials: MK
authors.lastname: Ang
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore. Electronic address: toh.chee.keong@singhealth.com.sg.
authors.forename: Chee-Keong
authors.initials: CK
authors.lastname: Toh
authors.affiliation: Divsion of Medical Sciences, Laboratory of Clinical Pharmacology, National Cancer Centre, Singapore. Electronic address: ctebal@nccs.com.sg.
authors.forename: Balram
authors.initials: B
authors.lastname: Chowbay
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore. Electronic address: Ravindran.kanesvaran@singhealth.com.sg.
authors.forename: Ravindran
authors.initials: R
authors.lastname: Kanesvaran
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore. Electronic address: tan.eng.huat@singhealth.com.sg.
authors.forename: Eng-Huat
authors.initials: EH
authors.lastname: Tan
mesh_terms: D059250:Administration, Metronomic; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*
keywords: Biomarkers; Cancer; Definition of metronomic chemotherapy; Metronomic chemotherapy