Cancer prevention, detection and treatment are changing fast. Oncologists from around the world, gathered at ASCO 2018, speak a new language. Why Doctor is sharing these new cancer words with you. Today: metronomy.
Interview with Professor of Oncology Gilles Freyer, also a breast specialist at the University Hospital of Lyon.
Dr Jean-François Lemoine: This new word is quite difficult to explain because we do not know it well, but doctors know it well: it is “metronomy”. Can you explain to us what it is?
Professor Gilles Freyer: This is a new concept administration of chemotherapy. You know that chemotherapy is a set of infusions (intravenous drugs) with all its attendant side effects that are so scary: hair loss, the risk of nausea, etc … If they are real, you have to tell people who read us, that there is no connection, for example, between hair loss and the severity of the disease or the heaviness of the chemotherapy. Some drugs are toxic to the hair and some are not. Fortunately, less and less people are losing their hair. Still, metronomy is the result of a reflection dating from the early 2000s, on the theme: “is it possible to find new methods of effective chemotherapy administration, which would bother people less and would be well tolerated? “.
Dr Jean-François Lemoine: So it is an ecological approach which consists in saying: “we will give more often, but less strongly”, is that it?
Professor Gilles Freyer: That’s it. And then it’s usually orally …
Dr Jean-François Lemoine: It may surprise people! Are some cancers being treated today without an infusion?
Professor Gilles Freyer: I would even say almost the majority of cancers today. First, there are the classic chemotherapy products, in oral form, which have been around for a very long time (almost 30 years for some of them) and which are being revisited. Then we have all the targeted therapies, which are no longer chemotherapy, but modern oral therapy.
Dr Jean-François Lemoine: So metronomy consists of taking medication more often. Does that mean every day?
Professor Gilles Freyer: It can be every day, or three times a week … Intravenous chemo usually comes once every 3 weeks – sometimes once a week but this is rarer. So we see that there is still a largely notable difference: the patient does not have to go to the hospital to take his tablet, the taking is done at home, with follow-up in consultation.
Dr Jean-François Lemoine: Are you sure that patients are taking their tablets?
Professor Gilles Freyer: In general, yes. Because the few studies that have been done show that the more serious the therapy, the more serious people are. The more serious the disease, the more people pay attention and invest in taking the treatment.
Dr Jean-François Lemoine: It’s great to give small doses more often, but me, if I had cancer, I would especially like to know if it works …
Professor Gilles Freyer: That works. As well ? There is question. These studies were carried out in the early 2000s and very few of them were comparative. They were just cohorts of people treated in this way, with results being reported. You know that today, if we want to be convincing, we have to compare them to intravenous chemotherapy or to the best standard treatments.
It is being done slowly. It should also be noted that these old chemotherapies I was talking about, which we take back, which we give in a daily form, are no longer supported by the pharmaceutical industry: there is no investment. These are things that have developed in a little bit of a plan-plan way, of course, without a lot of support. Today an international study was conducted on one of the drugs that we are talking about, which is called oral vinorelbine. She compares this method of administration, in this case three times a week compared to intravenous chemotherapy, and we will have the results during 2019.
Dr Jean-François Lemoine: Is it possible that we will meet again at ASCO 2021 and that all the drugs be administered orally and metronomically?
Professor Gilles Freyer: No, because unfortunately quite a few chemotherapy drugs are available in oral form. But we will have an enrichment of our possibilities: we will be able to offer people, depending on the stage of their disease, the severity, their symptoms and also their preferences (very important point) such or such type of drug, to have a more personalized approach. It is not precision medicine, because we are still dealing with a little classic chemotherapy, but personalized medicine. We try to do the best, taking into account the patient’s preferences.
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