Cancer Research, Statistics, and Treatment

: 2020  |  Volume : 3  |  Issue : 2  |  Page : 395--396

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

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

Correspondence Address:
Shweta Bansal
Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra

How to cite this article:
Bansal S. From no hope to some hope: Metronomic therapy in pediatric cancer.Cancer Res Stat Treat 2020;3:395-396

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 2021 Dec 4 ];3:395-396
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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.

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