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- Oncology and Cancer Research
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- Gynecologic Oncology
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- Cancer Therapeutics and Novel Approaches
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- Pulmonary oncology
Brain tumours are the second common neoplasms in children, after leukaemias.
Some brain tumours are unresectable, which are located in an inaccessible place in the brain, for surgeons or remove it and surgery may have to destroy or damage nearby healthy brain tissue or cause mortality or severe morbidities such as speech or movement dysfunction.
The surgeon determines if a patient's brain tumour is inoperable, so it is advisable to seek a second approach such as stereotactic radiosurgery or palliative conventional chemotherapy or radiation therapy, but there isn't,t new radiosurgery method in developing countries or conventional cytotoxic therapy haven,t sufficient efficacy. Metronomic chemotherapy€ is an unexpensive way to regress inoperable brain tumours such as ependymoma, brainstem glioma, and medulloblastoma and destroy inoperable tumours with different mechanisms.
Anti-angiogenesis effect is common mechanisms of metronomic chemotherapy while prominently decreasing undesirable toxic adverse effects can use for inhibiting unresectable solid tumours, but the main mechanism against inoperable tumours is immuno-surveillance intensification especially T cells (TREG) inhibition.
TREG can inhibit the anti-tumour immune response by suppressing the activity of both tumour-specific (CD8+ cytotoxic T lymphocytes and CD4+ T helper cells) and tumour-unspecific effector cells (natural killer [NK] and NK T cells.
Increased frequency of TREG cells can correlate with tumour progression and loss of treatment response. ( 5) Moreover, impairment of TREG activity by either specific blockade or depletion can enhance the immune response against tumour-associated antigens.
A sample metronomic regimen for meduloblastoma include:
1.Celecoxib 250 mg/m2 PO b.i.d day 1 to 43
2.Etoposide 50 mg/m2 po(21 days) plus
3. Cyclophosphamide 2.5 mg/kg/d po day 22 to 43
4. Fenofibrate(90 mg/m2/d) day 1 to 43
5. Thalidomide (6–12 mg/kg po every day; maximum daily dose 800 mg) day 1 to 43
6.Bevacizumab 10mg/kg weekly day 15 to 29
7.liposomal Cytarabine 25-50 mg intraventricular every 4 week day 29
For a median of 15.4 months
Although complete responses stay rare, these solutions mainly lead to long-term disease stabilization and significant improvement in the quality of life among children with inoperable brain tumours.
Despite clinical success in adults the administration of metronomic treatments in pediatric oncology is still in its early stage as a result of the lack of state-of-the-art clinical studies clearly demonstrating efficacy, but this approach is an inexpensive option in developing countries.
Keywords: metronomic chemotherapy, inoperable brain tumours
- Hematology oncology