Metronomic chemotherapy in resource-limited settings: evidence, opportunities, and future directions.

Metronomic chemotherapy-frequent, continuous delivery of low-dose chemotherapeutic drugs without drug-free breaks-is a promising treatment option for resource-limited situations. This narrative review analyzes the scientific justification, clinical evidence, cost-effectiveness, implementation challenges, and prospective developments of metronomic chemotherapy in low- and middle-income countries (LMICs), which account for 80% of childhood cancers and a rising incidence of adult malignancies. Metronomic regimens provide accessible and cost-effective therapy alternatives by targeting tumor vasculature, cancer stem cells, and the immunological milieu, all while preserving good safety profiles and allowing for oral administration in an outpatient setting. Clinical trials demonstrate efficacy across various tumor types, particularly in palliative care and maintenance therapy. Cost-effectiveness assessments demonstrate significant economic advantages, with annual treatment expenses as little as $130 USD in contrast to thousands for traditional or targeted therapy. Nonetheless, obstacles to implementation such as drug accessibility, constraints in healthcare infrastructure, and the necessity for evidence-based protocols persist as considerable problems. This study consolidates existing research and suggests strategic methods to enhance the use of metronomic chemotherapy in resource-limited healthcare settings.