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Wu HL, Zhou HX, Chen LM, Wang SS. Metronomic chemotherapy in cancer treatment: new wine in an old bottle. Theranostics 2024; 14:3548-3564. [PMID: 38948068 PMCID: PMC11209710 DOI: 10.7150/thno.95619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/26/2024] [Indexed: 07/02/2024] Open
Abstract
Over the past two decades, metronomic chemotherapy has gained considerable attention and has demonstrated remarkable success in the treatment of cancer. Through chronic administration and low-dose regimens, metronomic chemotherapy is associated with fewer adverse events but still effectively induces disease control. The identification of its antiangiogenic properties, direct impact on cancer cells, immunomodulatory effects on the tumour microenvironment, and metabolic reprogramming ability has established the intrinsic multitargeted nature of this therapeutic approach. Recently, the utilization of metronomic chemotherapy has evolved from salvage treatment for metastatic disease to adjuvant maintenance therapy for high-risk cancer patients, which has been prompted by the success of several substantial phase III trials. In this review, we delve into the mechanisms underlying the antitumour effects of metronomic chemotherapy and provide insights into potential combinations with other therapies for the treatment of various malignancies. Additionally, we discuss health-economic advantages and candidates for the utilization of this treatment option.
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Affiliation(s)
| | | | | | - Shu-sen Wang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
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2
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Sweet KL, Cortes JE, Apperley JF, Mann M, Mauro MJ, Oehler VG, Ruiz C, Schiffer CA, Ehrlich LA, Pamuk GE, Wynne J, Mehta GU, Okusanya OO, de Claro RA, Theoret MR, Smith BD, Norsworthy KJ. Project Confirm: Accelerated Drug Approvals for CML-Response. Clin Cancer Res 2024; 30:237-238. [PMID: 38178776 PMCID: PMC10783534 DOI: 10.1158/1078-0432.ccr-23-3234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024]
Affiliation(s)
| | | | | | | | - Michael J. Mauro
- Myeloproliferative Neoplasms Program, Memorial Sloan
Kettering Cancer Center, New York City, NY
| | - Vivian G. Oehler
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care
Alliance, Seattle, WA
| | | | - Charles A. Schiffer
- Department of Hematology-Oncology, Karmanos Cancer Center
at Wayne State University, Detroit, MI
| | - Lori A. Ehrlich
- Center for Drug Evaluation and Research, U.S. Food and Drug
Administration, Washington, DC
| | - Gulsum E. Pamuk
- Center for Drug Evaluation and Research, U.S. Food and Drug
Administration, Washington, DC
| | - Joseph Wynne
- Center for Drug Evaluation and Research, U.S. Food and Drug
Administration, Washington, DC
| | - Gautam U. Mehta
- Center for Drug Evaluation and Research, U.S. Food and Drug
Administration, Washington, DC
| | - Olanrewaju O. Okusanya
- Center for Drug Evaluation and Research, U.S. Food and Drug
Administration, Washington, DC
| | - R. Angelo de Claro
- Center for Drug Evaluation and Research, U.S. Food and Drug
Administration, Washington, DC
| | - Marc R. Theoret
- Oncology Center of Excellence, U.S. Food and Drug
Administration, Washington, DC
| | - B. Douglas Smith
- The Sidney Kimmel Comprehensive Cancer Center at Johns
Hopkins, Baltimore, MD
| | - Kelly J. Norsworthy
- Center for Drug Evaluation and Research, U.S. Food and Drug
Administration, Washington, DC
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3
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Beumer JH, Salamone SJ. Project Confirm: Accelerated Drug Approvals for CML-Letter. Clin Cancer Res 2024; 30:235-236. [PMID: 38178775 PMCID: PMC10783536 DOI: 10.1158/1078-0432.ccr-23-2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Jan H. Beumer
- Cancer Therapeutics Program, UPMC Hillman Cancer Center,
Pittsburgh, PA 15213
- Division of Hematology-Oncology, Department of Medicine,
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
- Department of Pharmaceutical Sciences, School of Pharmacy,
University of Pittsburgh. Pittsburgh, PA 15261
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4
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Walson PD. Personalized Minimal Effective Concentration Therapy. Clin Ther 2023; 45:1289-1292. [PMID: 37838561 DOI: 10.1016/j.clinthera.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/22/2023] [Accepted: 09/17/2023] [Indexed: 10/16/2023]
Abstract
It has been recognized for literally centuries that patients should be given only the amount of medication necessary to treat disease(s) or relieve symptoms. It is also well known that this amount can vary greatly between patients or even over time in the same patient. The ability to identify this amount, that is, to "personalize" dosing, requires a reliable measure of a patient's response to treatment. The development of analytical methods for the accurate measurement of pharmacologically meaningful drug concentrations in physiologic fluids, combined with mathematical methods for reliable prediction of how dosing changes affect these concentrations, has led to the development of therapeutic drug management (TDM) for more effective individualization of dosing. Using TDM, clinicians modify dosing to achieve concentrations or exposures (ie, AUC) found to be effective in patients with similar clinical attributes and conditions. These concentrations, called therapeutic (or target) concentrations or exposure ranges (TRs), are specific to both disease/condition and patient population. TDM is routinely used by many clinicians to adjust dosing of a wide range of medications for maximal efficacy and limited toxicity, thereby improving clinical outcomes. Failure to properly perform TDM or to appreciate the limitations of TDM have, however, contributed to the delayed acceptance of TDM by clinicians. This Commentary briefly discusses the limitations and the benefits of TR-guided TDM, and then discusses immunosuppressant drugs and anticancer medications as examples of drugs that require clinicians to change their prescribing practices from giving all patients the same or maximal tolerated doses, to instead adjusting individual doses to achieve minimal effective concentrations identified using circulating tumor- or graft-derived DNA or copy number instability rather than published TRs.
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Affiliation(s)
- Philip D Walson
- Department of Clinical Pharmacology, University Medical School Goettingen, Hannover, Germany.
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5
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Bruno R, Chanu P, Kågedal M, Mercier F, Yoshida K, Guedj J, Li C, Beyer U, Jin JY. Support to early clinical decisions in drug development and personalised medicine with checkpoint inhibitors using dynamic biomarker-overall survival models. Br J Cancer 2023; 129:1383-1388. [PMID: 36765177 PMCID: PMC10628227 DOI: 10.1038/s41416-023-02190-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/12/2023] Open
Abstract
Longitudinal models of biomarkers such as tumour size dynamics capture treatment efficacy and predict treatment outcome (overall survival) of a variety of anticancer therapies, including chemotherapies, targeted therapies, immunotherapies and their combinations. These pharmacological endpoints like tumour dynamic (tumour growth inhibition) metrics have been proposed as alternative endpoints to complement the classical RECIST endpoints (objective response rate, progression-free survival) to support early decisions both at the study level in drug development as well as at the patients level in personalised therapy with checkpoint inhibitors. This perspective paper presents recent developments and future directions to enable wider and robust use of model-based decision frameworks based on pharmacological endpoints.
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Affiliation(s)
- René Bruno
- Clinical Pharmacology, Genentech-Roche, Marseille, France.
| | - Pascal Chanu
- Clinical Pharmacology, Genentech-Roche, Lyon, France
| | - Matts Kågedal
- Clinical Pharmacology, Genentech-Roche, Solna, Sweden
| | | | - Kenta Yoshida
- Clinical Pharmacology, Genentech, South San Francisco, CA, USA
| | | | - Chunze Li
- Clinical Pharmacology, Genentech, South San Francisco, CA, USA
| | | | - Jin Y Jin
- Clinical Pharmacology, Genentech, South San Francisco, CA, USA
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Harvey RD. The earlier the better? Or better late than never? Dose optimization in oncology. J Natl Cancer Inst 2023; 115:485-487. [PMID: 36919765 PMCID: PMC10165476 DOI: 10.1093/jnci/djad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/08/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- R Donald Harvey
- Departments of Hematology and Medical Oncology and Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
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7
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Overbeek JK, Ter Heine R, Verheul HMW, Chatelut E, Rudek MA, Gurney H, Plummer R, Gilbert DC, Buclin T, Burger DM, Bloemendal HJ, van Erp NP. Off-label, but on target: the evidence needed to implement alternative dosing regimens of anticancer drugs. ESMO Open 2023; 8:100749. [PMID: 36603522 PMCID: PMC9813708 DOI: 10.1016/j.esmoop.2022.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- J K Overbeek
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - R Ter Heine
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - H M W Verheul
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Medical Oncology, Erasmus University MC Cancer Institute, Rotterdam, Netherlands
| | - E Chatelut
- Institut Claudius-Regaud, IUCT-Oncopole, and CRCT, Université de Toulouse, Inserm, 1, Toulouse, France; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore
| | - M A Rudek
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, USA; Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore; Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - H Gurney
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, Australia
| | - R Plummer
- Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | - D C Gilbert
- MRC Clinical Trials Unit, University College London (UCL), Institute of Clinical Trials and Methodology, London, UK; Optimal Cancer Care Alliance, Ann Arbor, USA
| | - T Buclin
- Division of Clinical Pharmacology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - D M Burger
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - H J Bloemendal
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen
| | - N P van Erp
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
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