peterz54
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Posts:12
i've seen published reports in the literature which suggest metronomic chemotherapy may be helpful. But I've seen nothing to suggest is has become a recommended part of any protocal.
For a patient who is too weak to tolerate standard max dose therapy in second line (ECOG 3 after 1st line), and for whom surgery is not an option, would metronomic chemo make sense?
thank you,
peter
Forums
Reply # - August 18, 2012, 11:21 AM
Reply To: Metronomic chemotherapy – is there a role?
Hi peter,
It is certainly true that dosing can be adjusted to accommodate the overall health of a patient, the use of metronomic chemo has not become common. There was a discussion which touched on some of the problems associated with it here: http://cancergrace.org/forums/index.php?topic=9416.0
JimC
Forum moderator
Reply # - August 18, 2012, 12:00 PM
Reply To: Metronomic chemotherapy – is there a role?
Peter, I'm so sorry to hear your wife isn't doing better. I hope she is able to rally on 2nd line therapy. Did she respond well to 1st line. If so she may be able to take a treatment break to recoup.
Thanks Jim you got to the answer faster than I was able. But I think I now know more than I need to on the subject. It hasn't been vetted to show better outcomes no matter the ECOG score of a patient.
Peter your wife was probably on a platinum doublet that can be very difficult for the patient. A second line single agent can very possibly be easier on her.
Reply # - August 18, 2012, 02:57 PM
Reply To: Metronomic chemotherapy – is there a role?
My perspective is that everything you've concluded from your outside reading and the comments above is accurate. It's not particularly well studied, or at least very far from proven to be beneficial, but it's at least likely to be minimally toxic and therefore feasible to give to people who have a marginal performance status. I just tend to see that the people who are its biggest proponents tend to make claims that far exceed the evidence, and I am concerned that it is a concept most adopted by charlatans who are motivated to capitalize on the concept as a profitable business opportunity -- especially since very frequent low dose chemotherapy happens to be an exceptionally profitable way to deliver chemotherapy.
Overall, I wouldn't rule out that it could be beneficial, but I really dislike when the marketing of any concept far exceeds the evidence to support it. As it is now, I see the practitioners of metronomic therapy as a modern oncology iteration of homeopathic medicine, which is appealing for being minimally toxic, even if it is also minimally (or completely non-) effective. But by the time you've learned that, the practitioner already has your (or the insurer's) money. And as this is perpetuated, the enthusiastic proponents never seem to manage to produce substantial evidence to back their tenuous claims.
-Dr. West