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Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists

PURPOSE: Low- and middle-income countries (LMICs) experience the burden of 80% of new childhood cancer cases worldwide, with cure rates as low as 10% in some countries. Metronomics combines frequent administrations of low-dose chemotherapy with drug repurposing, which consists of using already-appro...

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Autores principales: Revon-Rivière, Gabriel, Banavali, Shripad, Heississen, Laila, Gomez Garcia, Wendy, Abdolkarimi, Babak, Vaithilingum, Manickavallie, Li, Chi-Kong, Leung, Ping Chung, Malik, Prabhat, Pasquier, Eddy, Epelman, Sidnei, Chantada, Guillermo, André, Nicolas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Clinical Oncology 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613668/
https://www.ncbi.nlm.nih.gov/pubmed/31260397
http://dx.doi.org/10.1200/JGO.18.00244
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author Revon-Rivière, Gabriel
Banavali, Shripad
Heississen, Laila
Gomez Garcia, Wendy
Abdolkarimi, Babak
Vaithilingum, Manickavallie
Li, Chi-Kong
Leung, Ping Chung
Malik, Prabhat
Pasquier, Eddy
Epelman, Sidnei
Chantada, Guillermo
André, Nicolas
author_facet Revon-Rivière, Gabriel
Banavali, Shripad
Heississen, Laila
Gomez Garcia, Wendy
Abdolkarimi, Babak
Vaithilingum, Manickavallie
Li, Chi-Kong
Leung, Ping Chung
Malik, Prabhat
Pasquier, Eddy
Epelman, Sidnei
Chantada, Guillermo
André, Nicolas
author_sort Revon-Rivière, Gabriel
collection PubMed
description PURPOSE: Low- and middle-income countries (LMICs) experience the burden of 80% of new childhood cancer cases worldwide, with cure rates as low as 10% in some countries. Metronomics combines frequent administrations of low-dose chemotherapy with drug repurposing, which consists of using already-approved drugs for new medical applications. With wide availability, limited costs, and little infrastructure needs, metronomics can be part of constraint-adapted regimens in these resource-limited settings—with the understanding that metronomics shall not be a substitute for standard treatments when available and doable. Our study aims to describe the experience, practices, opinions, and needs in metronomics of physicians working in LMICs. METHODS: An online questionnaire was sent to more than 1,200 physicians in pediatric oncology networks in LMICs. Items included the type of center, physician’s demographics, experience in pediatric oncology, and experience with current knowledge of metronomics. Opinions and perspectives were explored using multiple-answer and open questions. RESULTS: Of physicians, 17% responded. Of respondents, 54.9% declared that they had already used a metronomic regimen. The most frequently cited repositioned drugs were celecoxib (44%) followed by propranolol and valproic acid (17%). Respondents highlighted the advantages of outpatient use (20%) and expected low toxicity (24%). In considering the drawbacks of metronomics, 47% of responses highlighted the lack of scientific evidence or guidelines, 33% the availability or affordability of drugs, and 18% the problem of acceptance or compliance. Of physicians, 79% believed that use of metronomics will spread in LMICs in the near future and 98% of them were willing to participate in international metronomic protocols or registries. CONCLUSION: Metronomics is already used in LMICs and is a potential answer to unmet needs in pediatric oncology. There is room for improvement in the availability of drugs and a necessity to develop collaborative protocols and research to generate level A evidence.
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spelling pubmed-66136682019-07-09 Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists Revon-Rivière, Gabriel Banavali, Shripad Heississen, Laila Gomez Garcia, Wendy Abdolkarimi, Babak Vaithilingum, Manickavallie Li, Chi-Kong Leung, Ping Chung Malik, Prabhat Pasquier, Eddy Epelman, Sidnei Chantada, Guillermo André, Nicolas J Glob Oncol Original Report PURPOSE: Low- and middle-income countries (LMICs) experience the burden of 80% of new childhood cancer cases worldwide, with cure rates as low as 10% in some countries. Metronomics combines frequent administrations of low-dose chemotherapy with drug repurposing, which consists of using already-approved drugs for new medical applications. With wide availability, limited costs, and little infrastructure needs, metronomics can be part of constraint-adapted regimens in these resource-limited settings—with the understanding that metronomics shall not be a substitute for standard treatments when available and doable. Our study aims to describe the experience, practices, opinions, and needs in metronomics of physicians working in LMICs. METHODS: An online questionnaire was sent to more than 1,200 physicians in pediatric oncology networks in LMICs. Items included the type of center, physician’s demographics, experience in pediatric oncology, and experience with current knowledge of metronomics. Opinions and perspectives were explored using multiple-answer and open questions. RESULTS: Of physicians, 17% responded. Of respondents, 54.9% declared that they had already used a metronomic regimen. The most frequently cited repositioned drugs were celecoxib (44%) followed by propranolol and valproic acid (17%). Respondents highlighted the advantages of outpatient use (20%) and expected low toxicity (24%). In considering the drawbacks of metronomics, 47% of responses highlighted the lack of scientific evidence or guidelines, 33% the availability or affordability of drugs, and 18% the problem of acceptance or compliance. Of physicians, 79% believed that use of metronomics will spread in LMICs in the near future and 98% of them were willing to participate in international metronomic protocols or registries. CONCLUSION: Metronomics is already used in LMICs and is a potential answer to unmet needs in pediatric oncology. There is room for improvement in the availability of drugs and a necessity to develop collaborative protocols and research to generate level A evidence. American Society of Clinical Oncology 2019-07-01 /pmc/articles/PMC6613668/ /pubmed/31260397 http://dx.doi.org/10.1200/JGO.18.00244 Text en © 2019 by American Society of Clinical Oncology https://creativecommons.org/licenses/by/4.0/ Licensed under the Creative Commons Attribution 4.0 License: https://creativecommons.org/licenses/by/4.0/
spellingShingle Original Report
Revon-Rivière, Gabriel
Banavali, Shripad
Heississen, Laila
Gomez Garcia, Wendy
Abdolkarimi, Babak
Vaithilingum, Manickavallie
Li, Chi-Kong
Leung, Ping Chung
Malik, Prabhat
Pasquier, Eddy
Epelman, Sidnei
Chantada, Guillermo
André, Nicolas
Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists
title Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists
title_full Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists
title_fullStr Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists
title_full_unstemmed Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists
title_short Metronomic Chemotherapy for Children in Low- and Middle-Income Countries: Survey of Current Practices and Opinions of Pediatric Oncologists
title_sort metronomic chemotherapy for children in low- and middle-income countries: survey of current practices and opinions of pediatric oncologists
topic Original Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613668/
https://www.ncbi.nlm.nih.gov/pubmed/31260397
http://dx.doi.org/10.1200/JGO.18.00244
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