Metronomic Chemotherapy Dosing

metronome
An old fashioned metronome.

What is Metronomic Dosing?

Metronomic chemotherapy dosing is a dosing schedule that includes lessened doses of chemo given more often.  

When I first debated if I would do chemo I was concerned.  I have a liver that is slower at processing. As a result I can start to feel symptoms of toxicity quicker and stronger than most.  I also didn’t want to stress my liver more than necessary.  So I started a search.  I didn’t know what I was searching for but I thought there had to be some kind of answer.

My Discovery of Metronomic Dosing

Eventually my research brought me to metronomic chemotherapy dosing.  Rather than giving one large dose of chemo drugs once a cycle, chemo is broken down into several smaller doses.  The result, it was claimed, would be fewer side effects and potentially an even greater efficacy.  I thought that sounded perfect for me!

At my next appointment I presented my thoughts to my doc and surprisingly (to me) he carefully considered my ideas.  He responded telling me that carboplatin was processed through the kidneys so not an issue for my liver.  Taxol (Paclitaxel), on the other hand, was processed by the liver and would be the best candidate for metronomic dosing for me. Since some of the side effects of Taxol are not fun it is a good candidate for metronomic dosing since it would potentially lessen the side effects.  

Metronomic Chemo Schedule

A schedule was created where I would receive a full dose of carbo on week one along with a 1/3 dose of taxol.  The following two weeks would each see me getting another 1/3 dose of taxol on each of those weeks.  All together I’d get the standard dosing but spread out over three weeks with one week after that where I was off and didn’t receive any chemotherapy.  

  • Week 1 – full dose of Carbo; 1/3 dose of Taxol
  • Week 2 – 1/3 dose of Taxol
  • Week 3 – 1/3 dose of Taxol
  • Week 4 – Off week

Pros and Cons of Metronomic Dosing

I loved the idea and quickly agreed to the schedule.  I asked my doc why more people weren’t doing this treatment schedule.  He said he wasn’t sure although it might have to do with the extra time it takes.  It seems to me that anything diminishing chemo symptoms would be well worth checking out.  I can now tell you a few of the drawbacks, none of which would keep me from doing it again. He also told me there was little evidence in the journals saying that the side effects are better with metronomic dosing but he didn’t think that could possibly be true between his experience and plain old common sense.

Cons – you have to be at the infusion center three times a cycle rather than just once.  That might be really difficult for many.  In addition, there are three visits, additional fees are involved in the treatment since pre-meds are administered three times rather than just once. Labs are also drawn three times.  

Pros – the main benefit as far as I’m concerned is the fact that my body is not getting slammed with the higher dosage all at once since it is spread out in three infusions over three weeks.  I’ve had few side effects associated with my chemo treatment so far and the ones I’ve had have been relatively mild and manageable.

There is a pattern to chemo one learns fairly quickly into the treatments.  I believe that those who do regular schedules may have a few better days since they are infusion free for longer periods between treatments.  Since I only have that fourth week, I might have fewer days of feeling more like myself.  Still, I wouldn’t consider any other form of dosing.

Conclusion

My personal belief is that metronomic dosing of chemotherapy is a worthwhile option for many people as long as they can afford the additional time in the infusion center.  It has been so much easier on my body than I ever would have expected.  Plus, I believe that it might just be more effective in killing cancer cells since the chemo is circulating throughout the body for longer, more continual periods of time.  

Want to keep your hair?

Oh, I almost forgot one of the biggest benefits of metronomic chemotherapy.  While I have lost hair, I am not bald!  Now that’s a real benefit!

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