propranolol + celecoxib + cyclophosphamide + etoposide + vinblastine

This metronomic chemotherapy regimen was developed by the University of Cologne for the treatment of children and adolescents with recurrent or progressive neuroblastoma. The regimen is a five-drug combination consisting of propranolol (a non-selective beta-blocker), celecoxib (a COX-2 inhibitor), and three cytotoxic agents: cyclophosphamide, etoposide, and vinblastine. Unlike traditional high-dose chemotherapy, this metronomic approach utilizes continuous, low-dose administration to target not only the tumor cells themselves but also the tumor-supporting vasculature (anti-angiogenesis) and the interactions between the tumor and the immune system. This strategy aims to maintain efficacy while significantly reducing treatment-related toxicity, allowing for outpatient administration and improved quality of life. The regimen is currently being evaluated in the Phase 2 METRO-NB2012 clinical trial.

Other names

METRO-NB regimenMetronomic Therapy in Recurrent Neuroblastoma