Clinical activity of metronomic chemotherapy in liver cancers

Abstract

Treating advanced hepatocellular carcinoma (HCC) remains challenging in clinical practice. Although sorafenib, an antiangiogenic targeted compound, has demonstrated survival benefits as a first-line therapy, the response rate and time to progression are not optimal. Metronomic chemotherapy has demonstrated antiangiogenic effects, and its reduced potential for toxicity renders it more tolerable to most advanced HCC patients. Clinical trials and retrospective studies have examined the use of metronomic chemotherapy, either alone or in combination with other antiangiogenic therapies, for treating advanced HCC. These studies have confirmed the feasibility and safety of metronomic therapy in patients with advanced HCC. Although objective responses were achieved using metronomic chemotherapy alone, it is difficult to discern the actual clinical benefits because of the small sample sizes of these studies. Nevertheless, metronomic chemotherapy can serve as a treatment option for advanced HCC patients who have progressed on or are intolerable to the standard therapy, sorafenib. In single-arm phase II clinical trials, combining metronomic chemotherapy with antiangiogenic targeted therapy has demonstrated improved efficacy for treating advanced HCC without increasing toxicities. Further research is warranted to confirm the benefits of combining metronomic chemotherapy with antiangiogenic targeted therapy for treating advanced HCC.