Superiority of metronomic chemotherapy compared to conventional mode in elderly people with advanced breast neoplasia

Introduction. Breast cancer is a serious disease with incidence steadily increasing with age. The evolution of its therapeutic management requires new strategies, including oral chemotherapy. Objective. To conduct a study in Eastern Algeria comparing two oral chemotherapy treatment regimens. Materials and Methods. Multicenter prospective study of 74 patients aged 65 years and older, treated and monitored for advanced breast cancer. Results. The onco-geriatric characteristics of the two groups were similar. Tolerance to metronomic chemotherapy was significantly better compared to conventional chemotherapy, as the proportion of grade 3-4 toxicities in the metronomic arm was low or absent. Regarding the impact of grade 3-4 toxicity on therapeutic management, we observed a significant decrease in the frequency of hospitalizations (p=0.012) and chemotherapy postponements (p<0.0001) in the group of patients who received the metronomic regimen compared to the group receiving the conventional regimen. The comparative study of objective response revealed significant superiority (p=0.003) of objective tumor response in the group of patients receiving metronomic chemotherapy compared to the other group (63.4% versus 54.5%). The study of overall survival and progression-free survival showed no significant difference between patients who received the conventional regimen and those who received the metronomic regimen. Discussion. Chronic administration of the metronomic regimen demonstrated significant superiority in objective tumor response and better tolerance compared to the conventional regimen without impairment of overall survival (OS) and progression-free survival (PFS). The durability of anti-tumor activity and negligible toxicity of this treatment suggest that this therapy constitutes an effective therapeutic option for elderly patients. Conclusion. Chronic administration of the metronomic oral regimen demonstrated significant superiority in objective tumor response and better tolerance compared to the conventional regimen without impaired survival. This approach, which targets angiogenesis, represents an effective specific treatment for elderly patients.