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The “cell kill” paradigm associated with maximum-tolerated dose (MTD) chemotherapy has shown remarkable success in many hematological malignancies, but unfortunately has failed to demonstrate sustained responses in majority of common advanced solid tumors. This failure can be attributable to heterogeneity of cancer cells within the tumor in terms of the rate of cell proliferation, genetic makeup, and micro-environmental selection giving rise to development of treatment resistance. In this context, Gatenby’s hypothesis of controlling tumor growth rather than eradicating it and treating it like a chronic disease may be more meaningful (1). The use of metronomic regimens alone or in combination with other new targeted therapies after MTD chemotherapy as maintenance treatment for longer period may pave the way for long-term cost-effective treatment.

Metronomics as Maintenance Treatment in Oncology: Time for Chemo-Switch