Conventional chemotherapy, which is given in cycles of maximum tolerated dosages, can cause toxic side-effects and drug resistance that limits clinical use of these drugs with cancer patients. To address these problems, researchers are investigating a new modality of chemotherapeutic drug regimens known as metronomic chemotherapy (MCT). The new dosing schedule involves continuous administration of conventional chemotherapeutic drugs at low doses for longer periods, without a lengthy drug-free period, when compared with conventional chemotherapy. This is done to inhibit the function of activated tumor endothelial cells in numerous cancers. When these new regimens destroy tumor angiogenesis and the formation of new blood vessel tumor cells, nutrients and oxygen cannot be supplied to the tumors which results in indirect inhibition of tumor growth and metastasis. The new regimens are beneficial to minimize adverse effects, reduce risk of developing acquired drug resistance, and improve quality of life in both adult and pediatric patients. Recently, the mechanism of MCT actions, which were studied at preclinical and clinical levels, described MCT as a multi-targeted therapy that inhibited tumor angiogenesis, restored anticancer immune response, and induction of tumor dormancy. Herein, this article reviews fundamental facts, mechanism of actions, chemotherapeutic drugs used in clinical trials as well as limitations of a low dose regimen for metronomic chemotherapy.
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