Department of Obstetrics and Gynecology, Yee-Zen Hospital, Tao-Yuan, Taiwan.
Taiwan J Obstet Gynecol. 2012 Jun;51(2):167-78. doi: 10.1016/j.tjog.2012.04.002.
Systemic administration of cytotoxic drugs is the primary treatment strategy for patients with advanced cancer. The effect of cytotoxic drugs is to disrupt the DNA of the cells, rendering them unable to replicate and finally killing them; therefore, the fundamental role of a wide range of treatment regimens is typically to induce lethal toxicity in the largest possible number of cancer cells. However, these cytotoxic drugs also damage the normal cells of the host, which limits the dose of the cytotoxic drug. Thus, cancer patients are usually treated at or near the maximum tolerated dose with the implicit intent of eradicating (curing) the tumor after balancing between efficacy in tumor killing and toxicity to the host. With significantly improving patient care, most efforts are focused on the corollary, "The higher the dose, the better." However, the concept that cancer could be considered as a chronic disease and might be treated like other chronic diseases to achieve a status called tumor dormancy is gaining popularity. In addition, there has been increasing interest in putting more effort into administering cytotoxic drugs on a more continuous basis, with a much shorter break period, or none at all, and generally lower doses of various cytotoxic drugs or combinations with other newer, targeted therapies, like anti-angiogenesis agents. This practice has come to be known as metronomic chemotherapy. There is still much to be learned in this field, especially with regard to optimization of the proper drugs, dose, schedule, and tumor type applications. This review will explore recent studies that have addressed the mechanism of metronomic chemotherapy in the management of various tumors, especially gynecologic cancers.
全身给予细胞毒性药物是治疗晚期癌症患者的主要治疗策略。细胞毒性药物的作用是破坏细胞的 DNA，使其无法复制，最终杀死它们；因此，广泛的治疗方案的基本作用通常是在尽可能多的癌细胞中诱导致死毒性。然而，这些细胞毒性药物也会损伤宿主的正常细胞，这限制了细胞毒性药物的剂量。因此，癌症患者通常以或接近最大耐受剂量进行治疗，其意图是在肿瘤杀伤效果和对宿主毒性之间取得平衡，从而根除（治愈）肿瘤。随着患者护理水平的显著提高，大多数努力都集中在推论上，即“剂量越高，效果越好”。然而，将癌症视为一种慢性病，并可以像治疗其他慢性病一样进行治疗，以达到肿瘤休眠的状态的概念正变得越来越流行。此外，人们越来越感兴趣的是，更连续地给予细胞毒性药物，休息时间更短，甚至没有休息时间，并且通常使用较低剂量的各种细胞毒性药物或与其他新型靶向治疗药物联合使用，如抗血管生成药物。这种做法被称为节拍化疗。在这一领域仍有许多需要学习的地方，特别是在适当药物、剂量、方案和肿瘤类型应用方面的优化。这篇综述将探讨最近的研究，这些研究探讨了节拍化疗在各种肿瘤（特别是妇科癌症）治疗中的作用机制。
