Mini-reviewResistance to metronomic chemotherapy and ways to overcome it

- Therapeutic resistance is a major determinant of cancer mortality.
- Mechanisms of resistance to metronomic versus conventional chemotherapy are distinct.
- Resistance to metronomic chemotherapy resembles resistance to other antivascular therapies.
- Resistance to metronomic chemotherapy is endothelial cell, tumor cell, or host-driven.

Therapeutic resistance is amongst the major determinants of cancer mortality. Contrary to initial expectations, antivascular therapies are equally prone to inherent or acquired resistance as other cancer treatment modalities. However, studies into resistance to vascular endothelial growth factor pathway inhibitors revealed distinct mechanisms of resistance compared to conventional cytotoxic therapy. While some of these novel mechanisms of resistance also appear to be functional regarding metronomic chemotherapy, herein we summarize available evidence for mechanisms of resistance specifically described in the context of metronomic chemotherapy. Numerous preclinically identified molecular targets and pathways represent promising avenues to overcome resistance and enhance the benefits achieved with metronomic chemotherapy eventually. However, there are considerable challenges to clinically translate the preclinical findings.