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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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society of Clinical Oncology
2019
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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. |
format | Online Article Text |
id | pubmed-6613668 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | American Society of Clinical Oncology |
record_format | MEDLINE/PubMed |
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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