Researchers from Spain have reported: “Maximum tolerated dose chemotherapy followed by metronomic chemotherapy” is a promising approach for treatment of patients with metastatic renal cell carcinoma (RCC). The details of this study were published early online in Lancet Oncology on February 16, 2010.[1]

Metronomic administration of chemotherapy is an area that has been evaluated in the palliative setting for patients with breast cancer, particularly among those who are not able to tolerate significant side effects. Metronomic administration (low-dose and rapid administration) allows for lower doses of therapy to be administered without a prolonged drug-free break with lower toxicities. Laboratory analysis has indicated that metronomic administration may enhance apoptotic and anti-angiogenic effects of therapy; trials continue to evaluate the efficacy of this approach.

The current study evaluated the effectiveness of maximum tolerated dose Gemzar® (gemcitabine) combined with metronomic Xeloda® (capecitabine) and Nexavar® (sorafenib) for treatment of 40 patients with metastatic RCC.

• Median progression-free survival (PFS) was 11.1 months.
• The partial response rate was 50%, with 17 patients (43%) having stable disease.
• There was one death from a pulmonary embolism. Grade 3 hematologic toxicity was observed in nine patients.

The authors concluded: “PFS and response rates were greater than those previously reported with gemcitabine and capecitabine or sorafenib monotherapy in patients with metastatic RCC. Adverse events were manageable in most patients. These findings provide preliminary confirmation of the synergistic activity of the chemo-switch concept seen in preclinical studies, and merit further exploration.”

Comments: This approach appears to have a high response rate with acceptable toxicity.

Reference: