Metronomic chemotherapy for triple negative breast cancer?

Breast cancer risk varies widely and increases with age. Despite the incidence for women older than 70 years being 33%, they are usually excluded from screening schedules and clinical trials. Furthermore, about 15% of breast cancers in older patients are of the triple-negative subtype (TNBC), which is known to be an aggressive histological subtype with very limited treatment options available, and associated with a very poor prognosis [1]. Indeed, the clinical management of elderly frail patients with TNBC can be complex and different from all the other breast cancer subtypes. Age-related factors such as comorbidities, deterioration of cognitive function, possible impairment in organ function and the concomitant use of other drugs, must be carefully assessed to avoid or minimize toxicity risks. In this context, low dose metronomic chemotherapy might represent a promising therapeutic option for elderly TNBC women [1]. Metronomic chemotherapy refers to the close, regular administration of conventional chemotherapy drugs at low, minimally toxic doses, with no prolonged break periods [2]. It has been shown to have an important stabilizing effect on cancer growth (including chemotherapy-resistant disease), to sometimes confer prolonged clinical benefits, and to have positive effects on the quality of life of patients with different types of cancer, by avoiding severe toxicities [3]