Journal of Blood & Lymph

Background: Here we report a case of complete response in patient with Metastatic Breast Cancer treated by metronomic Chemotherapy.
Case presentation: A 51 years old woman underwent righy mastectomy in may 2008. She performed firstline chemotherapy with doxorubicin every 21 days. The CT revaluation after ten cycle showed a partial response to treatment. It was decided to stop the treatment with doxorubicin and to start a metronomic therapy with cyclophosphamide 50 mg daily orally and Methotrexate 2.5 mg twice daily. After two months of this maintenance treatment, the CT scan showed a complete response.
The metronomic treatment is still ongoing, and after 45 months the patient maintains a complete response.
Conclusion: This clinical case also highlights how suitable metronomic chemotherapy can be as maintenance therapy, allowing long-term treatment with no relevant toxicity.

Based on predictive, preventive and personalized medicine (PPPM) strategy for treatment of cancer, immunotherapy and additional targeted anti-cancer modalities should be considered for cure of cancer at an early stage of the disease following successful conventional treatment. Alternatively, PPPM strategy should be applied at the stage of minimal residual disease (MRD) induced following successful re-induction of second or subsequent remission.
Fortunately, a stage of minimal residual disease can be accomplished in most patients with cancer following conventional treatment but in the absence of visible disease or lack of symptoms, additional treatment is usually denied. Considering PPPM using innovative and safe treatment focusing on immunotherapy should be considered for patients at risk because eradication of MRD can be accomplished whereas treatment of overt disease may no longer be possible. Similarly to the treatment of infectious diseases, the goal should be to recognize the high-risk cases upfront and treat MRD because residual malignant cells cannot be detected by available imaging technologies.
The take home message is that at the stage of minimal residual disease focusing on immunotherapy and other targeted anti-cancer modalities may be safe, successful and possibly the only way to cure cancer, or at least to better control tumor progression.