Metronomic chemotherapy in pediatric neuroblastoma

Metronomic chemotherapy (MC) is an innovative therapeutic approach that involves the chronic administration of low doses of chemotherapy agents. This strategy aims to sustain prolonged and active plasma levels of drugs, which can result in favorable tolerability. MC has shown promise in the treatment of hematologic and solid tumors, including high-risk neuroblastoma and relapsed/refractory (R/R) neuroblastoma. In the contemporary management of neuroblastoma, MC stands as a viable maintenance therapy for newly diagnosed patients lacking access to autologous stem cell transplantation or immunotherapy, particularly in resource-constrained regions. Furthermore, it serves as a pragmatic alternative for individuals intolerant to intensified regimens or undergoing palliative care for R/R neuroblastoma. Nevertheless, the quest for the optimal MC regimen persists, necessitating comprehensive investigations to delineate standardized protocols. Moreover, the identification of potential biomarkers or prognostic indicators assumes paramount significance in refining MC strategies for future breakthroughs in this domain. This review embarks on a comprehensive exploration of MC in neuroblastoma, offering insights into its historical underpinnings, diverse applications, adverse effect and future prospects, endeavoring to enrich our understanding of MC role in neuroblastoma management.