Skip Navigation


Annals of Oncology Advance Access originally published online on May 19, 2005
Annals of Oncology 2005 16(8):1243-1252; doi:10.1093/annonc/mdi240
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Supplementary Data
Right arrow All Versions of this Article:
16/8/1243    most recent
mdi240v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (18)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Bocci, G.
Right arrow Articles by Del Tacca, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bocci, G.
Right arrow Articles by Del Tacca, M.
Related Collections
Right arrow 2005 - Editors Choice
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© 2005 European Society for Medical Oncology

Cyclophosphamide-methotrexate ‘metronomic’ chemotherapy for the palliative treatment of metastatic breast cancer. A comparative pharmacoeconomic evaluation

G. Bocci1,*, M. Tuccori1, U. Emmenegger2, V. Liguori3, A. Falcone4, R. S. Kerbel2 and M. Del Tacca1

1 Division of Pharmacology and Chemotherapy, Department of Oncology, Transplants and Advanced Technologies, University of Pisa, Via Roma, Pisa, Italy; 2 Molecular and Cellular Biology Research, Sunnybrook and Women's College Health Sciences Centre, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; 3 Senior consultant of SAS®, Pisa; 4 U.O. Oncologia Medica, Ospedale Civile, Livorno, Italy

* Correspondence to: Dr G. Bocci, Division of Pharmacology and Chemotherapy, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Via Roma, 55, I-56126 Pisa, Italy. Tel: +39-050-830148; Fax: +39-050-562020; Email: g.bocci{at}med.unipi.it

Background:: Metronomic chemotherapy—the chronic administration of chemotherapy at relatively low, minimally toxic doses on a frequent schedule of administration at close regular intervals, with no prolonged drug-free breaks—is a potentially novel approach to the control of advanced cancer disease. It is thought to work primarily through antiangiogenic mechanisms and has, as an advantage, the property of significantly reducing undesirable toxic side-effects. The aim of the present study was to evaluate the cost effectiveness of cyclophosphamide-methotrexate ‘metronomic’ chemotherapy in the palliative treatment of pretreated metastatic breast cancer.

Methods:: Low-dose cyclophosphamide-methotrexate ‘metronomic’ chemotherapy was compared with outcome and resource utilisation data of published phase II trials regarding metastatic breast cancer, performed in western countries, mostly in Europe. All direct costs associated with metastatic breast cancer treatment were included and adjusted to year 2003 values. Sensitivity analyses were performed and variations to the values of key parameters were assessed.

Results:: Low-dose cyclophosphamide-methotrexate ‘metronomic’ therapy was assessed to be a cost-effective/cost-saving therapy for palliative treatment for metastatic breast cancer when compared with novel chemotherapy strategies (phase II trials). Compared with the 11 phase II mono- and combination chemotherapies, metronomic treatment showed marked cost savings in each case and improved cost effectiveness. Sensitivity analyses showed the results were robust to variations to the values of key parameters with very few exceptions.

Conclusions:: Metronomic cyclophosphamide-methotrexate is significantly cost effective. If validated by prospective randomized trials, the treatment concept could reduce healthcare costs, especially those associated with the combined use of new, highly expensive, molecularly targeted therapies.

Key words: metastatic breast cancer, metronomic chemotherapy, cyclophosphamide, methotrexate, pharmacoeconomics, cost-effectiveness ratio, sensitivity analysis


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Arch Otolaryngol Head Neck SurgHome page
M. Caballero, J. J. Grau, J. L. Blanch, J. Domingo-Domenech, J. M. Auge, W. Jimenez, and M. Bernal-Sprekelsen
Serum Vascular Endothelial Growth Factor as a Predictive Factor in Metronomic (Weekly) Paclitaxel Treatment for Advanced Head and Neck Cancer
Arch Otolaryngol Head Neck Surg, November 1, 2007; 133(11): 1143 - 1148.
[Abstract] [Full Text] [PDF]

Home page
 Molecular Cancer TherapeuticsHome page
J. Ma and D. J. Waxman
Collaboration between hepatic and intratumoral prodrug activation in a P450 prodrug-activation gene therapy model for cancer treatment
Mol. Cancer Ther., November 1, 2007; 6(11): 2879 - 2890.
[Abstract] [Full Text] [PDF]

Home page
 Molecular Cancer TherapeuticsHome page
U. Emmenegger, Y. Shaked, S. Man, G. Bocci, I. Spasojevic, G. Francia, A. Kouri, R. Coke, W. Cruz-Munoz, S. M. Ludeman, et al.
Pharmacodynamic and pharmacokinetic study of chronic low-dose metronomic cyclophosphamide therapy in mice
Mol. Cancer Ther., August 1, 2007; 6(8): 2280 - 2289.
[Abstract] [Full Text] [PDF]

Home page
 The OncologistHome page
A. Suvannasankha, C. Fausel, B. E. Juliar, C. T. Yiannoutsos, W. B. Fisher, R. H. Ansari, L. L. Wood, G. G. Smith, L. D. Cripe, and R. Abonour
Final Report of Toxicity and Efficacy of a Phase II Study of Oral Cyclophosphamide, Thalidomide, and Prednisone for Patients with Relapsed or Refractory Multiple Myeloma: A Hoosier Oncology Group Trial, HEM01-21
Oncologist, January 1, 2007; 12(1): 99 - 106.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
A. Bottini, D. Generali, M. P. Brizzi, S. B. Fox, A. Bersiga, S. Bonardi, G. Allevi, S. Aguggini, G. Bodini, M. Milani, et al.
Randomized Phase II Trial of Letrozole and Letrozole Plus Low-Dose Metronomic Oral Cyclophosphamide As Primary Systemic Treatment in Elderly Breast Cancer Patients
J. Clin. Oncol., August 1, 2006; 24(22): 3623 - 3628.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
D. Tassinari, B. Poggi, M. Fantini, E. Tamburini, S. Nicoletti, and S. Sartori
Cost-opportunity analysis in clinical oncology: from the 'wild far-west' to a correct integration of the disciplines, avoiding the 'war of the worlds'
Ann. Onc., May 1, 2006; 17(5): 876 - 877.
[Full Text] [PDF]

Home page
 Ann OncolHome page
G. Bocci, M. Tuccori, U. Emmenegger, V. Liguori, A. Falcone, R. S. Kerbel, and M. Del Tacca
Reply to the Letter to the Editor on 'Cost-opportunity analysis in clinical oncology: from the "wild far-west" to a correct integration of the disciplines, avoiding the "war of the worlds"', by D. Tassinari et al. (Ann Oncol 2006; 17: 876)
Ann. Onc., May 1, 2006; 17(5): 877 - 878.
[Full Text] [PDF]

Home page
 Cancer Res.Home page
U. Emmenegger, G. C. Morton, G. Francia, Y. Shaked, M. Franco, A. Weinerman, S. Man, and R. S. Kerbel
Low-Dose Metronomic Daily Cyclophosphamide and Weekly Tirapazamine: A Well-Tolerated Combination Regimen with Enhanced Efficacy That Exploits Tumor Hypoxia
Cancer Res., February 1, 2006; 66(3): 1664 - 1674.
[Abstract] [Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.