Metronomic Chemotherapy for Palliative Treatment of Metastatic Breast Cancer Patients

Background: Metronomic chemotherapy is believed to be of value in treatment of patients with metastatic breast cancer being cost effective, low toxicity profile chemotherapy. Patients and Methods: This study was carried in Radiation Oncology and Nuclear Medicine Department Ain Shams University Hospitals between April 2007 till June 2010. Patients with metastatic cancer previously treated received metronomic chemotherapy; oral Cyclophosphamide: 50mg tablet daily and oral Methotrexate: 2.5mg tablets twice daily on day 1 and 2 every week (arm A), and arm B: Included patients with the same eligibility criteria who received Vi-norelbine-cisplatine (Vinorelbine 25mg/m2 day 1 day 8 and Cisplatine 80mg/m2 day 1 every 21 day for 6 cycles) during the same period. Results: Fifty patients were treated in each group. There was no statistically significant difference between both groups regarding patients’ clinicopathological characteristics. With treatment in group A: One patient (2%) achieved CR, 18% (n:9) had PR, 52% (n:26) had SD, while 28% of the patients (n:14) experienced PD. In group B: Non of the patients achieved CR, 32% (n:16) showed PR, 46% (n:23) SD and 22% (n:11) had PD. There was no statistically significant difference between both study groups as regard objective tumor response (p-value= 0.973). In group A median time to disease progression was 4 months (rang: 2-17). While in group B: Median time was 6 months (rang: 2-20). There was no statistically significant difference between both groups regard-ing PFS (p-value=0.165). In group A, the median survival was 8 months while in group B, the median survival was 9 months (p-value=0.942). Toxicity was higher in group B as 2 patients (4%) experienced grade III anemia, one patient (2%) developed grade III thrombocytopenia, and two patients (4%) developed grade III neutropenia. Conclusion: Metronomic chemotherapy was well tolerated, cost effective line of treatment and achieved the same RR, PFS, and OS as navelbine/cisplatin regimen but with significantly lower toxicity.