Rationale for the use of metronomic chemotherapy in gastrointestinal cancer

Roberto Filippi, Pasquale Lombardi, Ilaria Depetris, Elisabetta Fenocchio, Virginia Quarà, Giovanna Chilà, Massimo Aglietta, Francesco Leone

Research output: Contribution to journalReview articlepeer-review


Introduction: Metronomic chemotherapy (mCT) is endowed with various properties, ranging from antiangiogenic to immunomodulation, and may revert tumor resistance to conventional drug administration. A variety of antineoplastic agents displayed activity when administered with metronomic schedules in preclinical models of gastrointestinal cancers. However, most of the field is still unexplored. Areas covered: Herein, the authors review the existing literature from PubMed, concerning the use of mCT in gastrointestinal oncology. Expert opinion: A mounting body of evidence is emerging in support of mCT as a treatment option for gastrointestinal tumors, but the frequent signs of clinical activity inconsistently translate into a benefit for survival. Research in this field should focus on providing high-quality evidence on the safety and efficacy of mCT, with more prospective, comparative trials; identifying the subgroups of patients for whom mCT would be the best approach; establishing standardized protocols based on mCT pharmacokinetics and pharmacodynamics; developing drug activity biomarkers. mCT is also potentially suitable for combinations with targeted antiangiogenic drugs and may be incorporated with conventional administration into dual regimens.

Original languageEnglish
Pages (from-to)1451-1463
Number of pages13
JournalExpert Opinion on Pharmacotherapy
Issue number13
Publication statusPublished - Sept 2 2018


  • capecitabine
  • colorectal cancer
  • cyclophosphamide
  • gastric cancer; biliary cancer
  • gastrointestinal tumors
  • hepatocellular carcinoma
  • Metronomic chemotherapy
  • pancreatic cancer

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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