The anti-angiogenic basis of metronomic chemotherapy.

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Nat Rev Cancer. 2004 Jun;4(6):423-36.

The anti-angiogenic basis of metronomic chemotherapy.

Kerbel RS, Kamen BA.

In addition to proliferating cancer cells and various types of normal cells, such as those of the
bone marrow, conventional cytotoxic chemotherapeutics affect the endothelium of the growing
tumour vasculature. The anti-angiogenic efficacy of chemotherapy seems to be optimized by
administering comparatively low doses of drug on a frequent or continuous schedule, with no
extended interruptions — sometimes referred to as ‘metronomic’ chemotherapy. In addition to
reduced acute toxicity, the efficacy of metronomic chemotherapy seems to increase when
administered in combination with specific anti-angiogenic drugs. Gaining better insight into the
mechanisms of these effects could lessen or even eliminate the empiricism used to determine the
optimal dose and schedule for metronomic chemotherapy regimens.