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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 395-396

From no hope to some hope: Metronomic therapy in pediatric cancer


Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India

Date of Submission08-Mar-2020
Date of Decision09-Mar-2020
Date of Acceptance14-Mar-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Shweta Bansal
Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_74_20

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How to cite this article:
Bansal S. From no hope to some hope: Metronomic therapy in pediatric cancer. Cancer Res Stat Treat 2020;3:395-6

How to cite this URL:
Bansal S. From no hope to some hope: Metronomic therapy in pediatric cancer. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 9];3:395-6. Available from: http://www.crstonline.com/text.asp?2020/3/2/395/287264



I would like to comment on an interesting article and accompanying editorial published in your journal regarding the use of oral metronomic therapy in childhood cancer.[1],[2] It was a good attempt by the authors to provide some real case scenario data about the safety and efficacy of oral metronomic therapy. However, the various limitations of the study make it less informative. Foremost, the design of the study was not conducive to establish the efficacy of metronomic therapy in the studied population. The efficacy of the drug should be tested under more stringent conditions in a well-designed clinical trial.[3] The data would have been more useful if the results had concentrated on the effectiveness and safety of the drug therapy and compared it with a population of patients where no intervention was done.

As the number of patients in each disease category was small, the information on the various issues associated with progressive disease in childhood cancer would have been more useful. The information on the palliation of the symptoms focusing on pain, decrease in the number of admissions in patients with progressive disease, anxiety among parents, and feeding issues would have made it much more useful for daily clinical practice.

In low- and middle-income country (LMIC) and MIC, the doctor-to-patient ratio and the limited availability of the standard of care for diseases like childhood cancer lead to overall poor survival due to multiple factors, as stated elsewhere.[4],[5] The use of metronomic therapy in such conditions can be useful and may be a bridge to definitive therapy till the patient is able to reach a center of excellence for cancer care. Hence, more studies are needed with specific aims and objectives and a well-defined patient population.

The prospective studies on metronomic therapy in curable or progressive childhood cancers will require accurate definitions and clear messages so that this therapy does not get substituted for curative treatment. In the era of increasing awareness and better treatment facilities, the focus is on treating the malignancies with curative intent. There has been the successful use of metronomic therapies in adult cancers,[6] however for pediatric malignancies only few phase I or II trials have been published.[7] These trials tried to use metronomic therapies as salvage treatment or to enhance the antitumoral effect in difficult malignancies like osteosarcoma.[8],[9],[10]

Our knowledge about the role of metronomic therapies in childhood cancer is still limited and well-designed studies can be useful in defining their role with the understanding that metronomic therapies should not be a substitute to standard treatment in treatment-responsive malignancies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar K, Radhakrishnan V, Dhanushkodi M, et al. Oral etoposide and cyclophosphamide: A low-cost palliative metronomic chemotherapy in advanced pediatric cancers. Cancer Res Stat Treat 2020;3:64-8.  Back to cited text no. 1
  [Full text]  
2.
Amegan-Aho KH. Surviving on less. Cancer Res Stat Treat 2020;3:87-8.  Back to cited text no. 2
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3.
Selker HP, Eichler HG, Stockbridge NL, McElwee NE, Dere WH, Cohen T, et al. Efficacy and effectiveness too trials: Clinical trial designs to generate evidence on efficacy and on effectiveness in wide practice. Clin Pharmacol Ther 2019;105:857-66.  Back to cited text no. 3
    
4.
Philip CC, Mathew A, John MJ. Cancer care: Challenges in the developing world. Cancer Res Stat Treat 2018;1:58-62,  Back to cited text no. 4
    
5.
Parambil BC, Ramanathan S. Improving outcomes in Rhabdomyosarcoma: The way ahead. Cancer Res Stat Treat 2019;2:69-71.  Back to cited text no. 5
  [Full text]  
6.
Simha V, Patil V, Joshi A, Prabhash K, Noronha V. Role of palliative chemotherapy and targeted therapy in advanced esophageal and gastroesophageal junction cancers. Cancer Res Stat Treat 2019;2:172-81.  Back to cited text no. 6
  [Full text]  
7.
Ali AM, El-Sayed MI. Metronomic chemotherapy and radiotherapy as salvage treatment in refractory or relapsed pediatric solid tumours. Curr Oncol 2016;23:e253-9.  Back to cited text no. 7
    
8.
Fousseyni T, Diawara M, Pasquier E, André N. Children treated with metronomic chemotherapy in a low-income country: METRO-MALI-01. J Pediatr Hematol Oncol 2011;33:31-4.  Back to cited text no. 8
    
9.
Senerchia AA, Macedo CR, Ferman S, Scopinaro M, Cacciavillano W, Boldrini E, et al. Results of a randomized, prospective clinical trial evaluating metronomic chemotherapy in nonmetastatic patients with high-grade, operable osteosarcomas of the extremities: A report from the Latin American Group of Osteosarcoma Treatment. Cancer 2017;123:1003-10.  Back to cited text no. 9
    
10.
Turkar S. Current treatment landscape and emerging management options for extremity sarcoma. Cancer Res Stat Treat 2018;1:121-38.  Back to cited text no. 10
  [Full text]  




 

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