Timing of Therapies: Chronomodulation and Metronomic Dosing

Author

Nancy Hepp, MS, BCCT Project Manager

Read more

Reviewer

Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher

Read more

Last updated December 21, 2020.

Key Points

  • Before using this therapy, consult your oncology team about interactions with other treatments and therapies. Also make sure this therapy is safe for use with any other medical conditions you may have.
  • Chronomodulation, or chronomodulated chemotherapy, involves administering chemotherapy drugs at optimal times of day when cancer cells may be more susceptible and/or when normal cells are less likely to be damaged by treatment.
  • Clinical evidence suggests some positive benefits of chronomodulated chemotherapy in treating the cancer and reducing the rate and severity of adverse reactions.
  • Early evidence is finding that prolonged, repetitive and more frequent low doses of chemotherapy drugs (metronomic chemotherapy) interferes with a process in cancer growth and reduces the cancer’s ability to become resistant.
  • Used in two integrative programs and protocols.

Chronomodulation

Chronomodulation, or chronomodulated chemotherapy, involves administering chemotherapy drugs at optimal times of day when cancer cells may be more susceptible and/or when normal cells are less likely to be damaged by treatment. The intended outcome is to make treatment more effective with fewer side effects.

Integrative oncologist and BCCT advisor Keith Block, MD, has been a pioneer of chronomodulated chemotherapy in the United States. A brief excerpt from his description:

Gold standard research supports the use of chronomodulated chemotherapy. For example, for metastatic colon cancer patients, studies show that administering chemotherapy at the optimal time can halve toxicity and double treatment response. For advanced metastatic ovarian cancer, a study in the journal Cancer reported that optimal timing of chemotherapy can reduce toxic side effects by 50 percent and quadruple five-year survival. This is a four-fold improvement! (Four times as many patients were alive at the five-year mark). The same study demonstrated a 75 percent reduction in the need to cut the treatment dose!1

Practical obstacles may make administering chemotherapy based on chronomodulation less available.  Giving drugs at odd times of the day or night (such as a colorectal cancer chemotherapy regimen of administration at 4am, 5am and 4pm) can be difficult to schedule, for example.2 US insurers may not reimburse for chronotherapy expenses.3

The patients' sex, genetic background, and lifestyle influenced responses and drug schedule tolerability4

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Clinical Evidence

General Cancer

Evidence shows benefit with acute lymphoblastic leukemia, ovarian cancer, endometrial uterine cancer, metastatic colorectal cancer, metastatic transitional cell carcinoma, bladder cancer, progressive metastatic renal cell carcinoma, breast carcinoma, lung carcinoma, hormone-refractory metastatic prostate cancer and genitourinary tract cancer.

Read more

Bladder Cancer

Read more

Colorectal Cancer

Read more

Kidney Cancer

Read more

Ovarian Cancer

Read more

Pancreatic Cancer

Read more

Lab and Animal Evidence

Read more

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Clinical Evidence

  • Reduced rate and severity of adverse reactions while achieving higher rates of complete and partial remissions compared to those getting continuous infusion chemo23  

Gastrointestinal Side Effects

Read more

Stomatitis

Read more

Lab and Animal Evidence

Read more

Low-Dose Metronomic Chemotherapy

Early research as well experience in clinical practice is finding that metronomic chemotherapy, administering prolonged, repetitive and more frequent low doses of chemotherapy drugs, has these advantages:

  • Interferes with the ability of the cancer to create its essential blood supply
  • Reduces the cancer’s ability to become resistant

In a 2019 scientific review article the authors state: “The evidence of metronomic chemotherapy for personalized medicine is growing, starting with unfit elderly patients and also for palliative treatment.”29 Other studies and reviews show benefit.30

BCCT plans to write a full summary on  chronomodulated therapies. While our summary is in development, you can visit these sources:

View All References

More Information

Enter your comments or questions below.

Comments (0)




Allowed tags: <b><i><br>Add a new comment: