Dr. Muss on the Use of Metronomic Chemotherapy in Metastatic Breast Cancer

Hyman B. Muss, MD, the Mary Jones Hudson Distinguished professor of Geriatric Oncology, Division of Oncology, the University of North Carolina (UNC) Lineberger School of Medicine, director, the Geriatric Oncology Program, UNC-Chapel Hill in Chapel Hill, discusses the use of metronomic chemotherapy in metastatic breast cancer.

Although new and emerging therapies represent new options for patients with metastatic breast cancer, there may come a time for some patients when it is not likely that any treatment will be extremely effective, Muss begins. At the 40th Annual Miami Breast Cancer Conference®, Muss spoke about the potential use of metronomic chemotherapy for patients who have reached this point. Although newer treatments may be very effective, they won’t work for all patients, Muss explains, adding that it's never a patient who fails a drug; treatments fail the patient.

When these treatments have been ruled out, but clinicians and patients still want to try another approach. However, this presents a difficult decision for clinicians, because although patients may want to try something, clinicians do not want to give a patient a drug that is not likely to work and could be very toxic, Muss emphasizes. Metronomic chemotherapy—smaller doses of chemotherapy given over a longer time—can represent an option. Several studies that included moderately to heavily pretreated patients examined doses of chemotherapy drugs, such as capecitabine, given in lower doses when compared with what is typically given in breast cancer, Muss adds. Other agents that can be used with metronomic dosing include liposomal doxorubicin and eribulin, Muss continues.

Findings from these studies showed very low toxicity rates and good responses, Muss says. This strategic approach can provide some hope for both the patient and their physician, Muss says. Additionally, this can helps patients physically by shrinking the tumor and improving the quality of life, Muss adds. Metronomic chemotherapy is a concept that has been used and tested in the appropriate population; these drugs are effective in breast cancer, and they can have a role in smaller doses for patients with limited options, Muss concludes.