title: Potential role of metronomic chemotherapy in the treatment of esophageal and gastroesophageal cancer.
abstract: Patients with esophagogastric cancer have poor prognoses in spite of the best available therapies. Patients are debilitated and may not tolerate, or may progress, on standard cytotoxic chemotherapy regimens. Metronomic chemotherapy is an attractive treatment option due to its very low reported toxicity, modest efficacy, low cost and ease of administration. Capecitabine is the most common drug used in metronomic scheduling; other drugs include cyclophosphamide and paclitaxel. Dosing of capecitabine can range from 1000 mg orally daily for 4 weeks on and 1 week off to a continuous dosing schedule of 1500 mg orally daily. Reported toxicities, including neutropenia, mucositis and hand-foot syndrome, occur in <10% of patients. As there is a lack of well-conducted, randomized clinical trials evaluating the role of metronomic chemotherapy in esophagogastric cancer, it cannot be recommended as the standard of care; however, it can be considered to be a therapeutic option, especially in elderly patients with relapsed disease for whom other therapeutic options are limited.
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Vanita
authors.initials: V
authors.lastname: Noronha
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Patil
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Chougule
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Shripad
authors.initials: S
authors.lastname: Banavali
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India. Electronic address: kumarprabhashtmh@gmail.com.
authors.forename: Kumar
authors.initials: K
authors.lastname: Prabhash
mesh_terms: D059250:Administration, Metronomic; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000069287:Capecitabine / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019317:Evidence-Based Medicine; D006801:Humans; D017239:Paclitaxel / Q000008:administration & dosage; D018579:Patient Selection; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000069287:Capecitabine; D003520:Cyclophosphamide; D017239:Paclitaxel
keywords: Esophagogastric; Esophagus; Gastric; Metronomic; Repurposing; Scheduling