What is Metronomic Chemotherapy ?

Metronomic chemotherapy is one of the biggest step forward in the history of cancer treatment and is based on the understanding of the blood supply in cancer tissue, or rather the possibility of controlling this so that the cancer cannot grow.

For the patients, this new way of treatment is very interesting because it practically has no side effects. The treatment primarily uses tablets and research shows that this gives equally good results as the ordinary chemotherapy, in which the highest possible doses are given every second or third week and which produces more or less serious side effects.

Since 1970 global angiogenesis research has taken place at the Judah Folkman laboratories at the Dana-Farber Institute in Boston USA . A majority of the world leading angiogenesis researchers have been working here or in other ways in close connection with Judah Folkman. Unfortunately, Judah Folkman died January the 14th 2008 at Denver Airport of a heart attack nearly 75-years old. For this reason, he unfortunately did not get the Nobel Prize in medicine, which he really had deserved.

Angiogenesis means creation of new blood vessels from an existing blood vessel and this is the most important way cancer cells use to get nutrition. Normal chemotherapy also destroys the endothelial cells in the small blood vessels but in the usual 2 – 3 weeks pause given before the next chemotherapy, the blood vessel grows into the cancer again.

On February 23rd 2008, at the 28th annual German Cancer Congress, the American cancer researcher D. McDonald from San Francisco presented an interesting lecture at a symposium entitled: “Anti-angiogenesis, Therapy for Solid Tumours”. McDonald showed pictures from his research and demonstrated that already one day after the treatment with an anti-angiogenesis remedy has been stopped, the endothelial cells (the cells in the walls of the blood vessels) start sprouting and sending out growth processes from the basal membrane. Within just one week from stopping the anti-angiogenesis treatment, the blood vessels and the blood supply to the cancer tumour are fully re-established. 

The metronomic chemotherapy, just like the fast rhythm in the metronome, given daily or every second day, does not allow the blood vessels to re-establish. It does not matter which cancer cells it is about or if perhaps they have become resistant. We do not attack cancer cells with the metronomic therapy, it is the blood vessels that are attacked. You can ask yourself if also the endothelial cells in the long run can become resistant - and the answer is yes. However it takes a much longer time then when the cancer cells become resistant and the normal process under metronomic treatment can be as follows: At first the tumour becomes smaller, then comes a long and stable period which can last for years and finally the cancer grows again. You can then shift to another metronomic chemotherapy or a combination of metronomic substances.

The following is an example of a long-lasting metronomic case story:

In January 2001 a 36-year old woman came for treatment at the San Carlo Hospital in Rome complaining of stomach pain and an enlarged girth. She had a raised CA-125 (tumour marker for ovarian cancer) at 182 (normal levels are less than 35) and an operation was performed (explorative laparotomy) where a tumour was found extending from the ovaries and which had grown together with the uterus, colon and the rectum. Also peritoneal carcinosis, (metastases in the peritoneum) and numerous metastases with a diameter of 3 cm in the omentum and behind the peritoneum. It was a so-called low-differentiated serous adenocarcinoma, FIGO stadium III c.

The patient had six cycles with Paclitaxel and Carboplatin every third week and the CA125 was then 102. The CT-scan, however, showed no response.  Another chemotherapy, Topotecane, was tried, but fifteen days after the start of the first cycle the patient developed ileus (intestinal obstruction) and had to be operated.  The laparotomy now showed an obstructing mass with widespread carcinosis in the diaphragm and on the surface of the liver.  A colostomy was performed and the planned Topotecane-treatment was discontinued because of severe weight loss and anemia. The CA-125 had gone up to 300.

With the patient’s agreement, in August 2001, metronomic chemotherapy was started with 50 mg cyclofosfamide daily in tablet form and with EPO and vitamins as supportive therapy.  Three months later the CA-125 was 90.  The CT showed stabilization and there was weight gain and cessation of anemia.

The patient continued this therapy for five years and lived a normal social and working life during this period.  The CA-125 stabilized around 50.  In July 2006 she developed bleeding from the bladder and a cystoscopy showed external compression of the bladder and a biopsy showed progression.  Unfortunately she died from severe bleeding before she was able to begin a new metronomic treatment.

This case-story from Italy illustrates magnificently the possibilities of metronomic chemotherapy.

Read more about metronomic chemotherapy and more case studies on the following pages.

Download and read the complete article here

Download and read the Kees article on
           Prostate Cancer here

Treatment of Prostatecancer - PSA reduction from
            814 to 0,1 with the KEES protocol

Treatment of Prostatecancer with Metronomic
            Chemotherapy

Treatment of Breastcancer with Metronomic 
            Chemotherapy