Mathematical modelling of toxicity-related trade-offs in metronomic chemotherapy

For better quality of life (QoL) for the cancer patients, metronomic chemotherapy (MCT) would be the rational option instead of conventional chemotherapy. However, in view of the recent arguments regarding the accumulation of toxicity in MCT, it is worthwhile to examine the role of pathophysiological constraints in retarding the curative potential of MCT. Drug application is stopped upon attaining a certain high level of toxicity and subsequent resumption is possible once the toxicity drops below a certain low level. Large delays in subsequent drug administration can thus effectively handle toxicity and it may retard the therapeutic potential due to excessive tumour growth in the absence of drug. Small delays, on the other hand, may result in inoperable pathophysiological states resulting in poor QoL. It is argued that only the intervention of domain knowledge of an expert oncologist with respect to drug administration decision can in fact clinch the trade-off issues arising out of the situation in favour of a sustainable QoL. A mathematical model that may act as a general guideline to tackle the trade-off issues in cancer treatment is provided. Rigorous simulation exercises are required to establish the concept of MCT in the backdrop of conventional cancer treatment practices.