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Pan-European Expert Meeting on the Use of Metronomic Chemotherapy in Advanced Breast Cancer Patients: The PENELOPE Project



Metronomic chemotherapy (mCHT) is a treatment regimen in which drugs are administered frequently or continuously and that maintains low, prolonged, and pharmacologically active plasma concentrations of drugs to avoid toxicity associated with traditional chemotherapy regimens, while achieving tumor response. Despite the increasing use of mCHT in patients with metastatic breast cancer (MBC) and the endorsement of mCHT in guidelines, no consensus exists about which patients may substantially benefit from mCHT, which agents can be recommended, and in which treatment setting mCHT is most appropriate.


In October 2017, ten international experts in the management of breast cancer convened to develop a report describing the current status of the use of mCHT for the treatment of advanced breast cancer, based not only on current literature but also on their opinion. The Delphi method was used to reach consensus.


A full consensus was reached concerning the acknowledgement that mCHT is not simply a different way of administering chemotherapy but a truly new treatment option. The best-known effect of mCHT is on angiogenesis inhibition, but exciting new data are on the way regarding potential activity on immune system activation. The experts strongly suggest that the ideal patients for mCHT are those with hormone receptor (HR)-positive tumors or those with triple-negative disease. Independently of HR status, mCHT could be an advantageous option for elderly patients, who are often under-treated simply because of their age.


Current data support the use of mCHT in selected patients with MBC.


Pierre Fabre.

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Fig. 1
Fig. 2

Adapted with permission from Romiti et al. [21]


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This study and associated article processing charges was funded by Pierre Fabre.

Editorial Assistance

We would like to thank Simone Tait of Springer Healthcare Communications who edited this manuscript for English before submission. This medical writing assistance was funded by Pierre Fabre.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Marina E Cazzaniga has received honoraria for participation in advisory boards for Pierre Fabre Pharma, Roche, Astra Zeneca, Novartis, and Celgene. Elisabetta Munzone has received honoraria for participation in advisory boards from Pierre Fabre Médicament. Guido Bocci has received honoraria for participation in advisory boards from Pierre Fabre Médicament. Noémia Afonso has received honoraria for participation in advisory boards from Pierre Fabre Médicament. Patricia Gomez has received honoraria for participation in advisory boards from Pierre Fabre Médicament. Edgar Petru has received honoraria for participation in advisory boards from Pierre Fabre Médicament. Xavier Pivot has received honoraria for participation in advisory boards from Pierre Fabre Médicament. Pedro Sánchez Rovira has received honoraria for participation in advisory boards from Pierre Fabre Médicament. Valter Torri has received honoraria for participation in advisory boards from Pierre Fabre Médicament. Sven Langkjer has received honoraria for participation in advisory boards of Pierre Fabre Médicament, research grants from the Danish Cancer Society, The Lundbeck Foundation and Pierre Fabre, and travel grants from Roche, Novartis, Bristol Myers Squibb and Pierre Fabre. Piotr J. Wysocki has received honoraria for advisory boards and speaker activities from Pierre Fabre Médicament, Roche, Astra Zeneca, Novartis, Pfizer, Eli Lilly.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Correspondence to Marina E. Cazzaniga.

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Cazzaniga, M.E., Munzone, E., Bocci, G. et al. Pan-European Expert Meeting on the Use of Metronomic Chemotherapy in Advanced Breast Cancer Patients: The PENELOPE Project. Adv Ther 36, 381–406 (2019).

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  • Breast cancer
  • Consensus meeting
  • Metronomic chemotherapy
  • Vinorelbine