eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2025-09-30 18 3 1917 1924 10.13005/bpj/3224 67221 article Giorgio Attina 1 Stefano Mastrangelo 1 Alberto Romano 1 Dario Tallo 1 Palma Maurizi 1 Antonio Ruggiero 1 Department of Woman and Child Health and Public Health, Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy. Traditionally, cancer treatment relied on the maximum tolerated dose (MTD) approach, in which chemotherapeutic agents are given at the highest dose that patients can tolerate, with scheduled breaks to allow for recovery. However, this method has notable drawbacks, including significant toxicity, tumor regrowth during drug-free intervals, and the development of resistance. Metronomic chemotherapy offers an innovative alternative, characterized by continuous low-dose administration without treatment interruptions. This approach primarily targets the tumor microenvironment, including tumor vasculature and cancer stem cells, while also affecting the immune system. By maintaining a steady level of drug exposure, metronomic therapy prevents the recovery of tumor endothelial cells and enhances immune surveillance, leading to prolonged disease stabilization and potentially improved long-term outcomes. Due to its reduced toxicity, cost-effectiveness, and suitability for oral administration, metronomic chemotherapy is especially beneficial for long-term maintenance therapy for the elderly, or frail patients. This review explores the mechanisms, clinical advantages, and challenges of metronomic chemotherapy, as well as its potential for integration with other treatment modalities to improve patient outcomes. Additional research is needed to optimize drug dosing, identify biomarkers for treatment response, and conduct large-scale clinical trials comparing metronomic approaches with standard chemotherapy regimens. https://biomedpharmajournal.org/vol18no3/metronomic-chemotherapy-an-alternative-strategy-in-cancer-treatment-based-on-continuous-low-dose-administration/ Cancer Chemotherapy Drug dosing Metronomic Toxicity