Metronomic chemotherapy (MC) is defined as the frequent administration of chemotherapy at doses below the maximal tolerated dose (MTD) and with no prolonged drug-free break or simply “lower doses, longer times”. MC well adapted to low- and middleincome countries.  Objective: The aim of this study was to describe the use of MC and assess the safety of MC drugs given to children with refractory, relapse and advance cancer of various tumor types.  Methods: This prospective observational study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2016 to January 2019. This study evaluated the outcome and safety of MC with orally available cytotoxic drugs, Cyclophosphamide (50mg/m2 /dose) and Etoposide (50mg/m2 /dose) daily for 21days followed by 1-week break, Sodium Valproate (Valproic acid)- 10- 15mg/kg/day for 21 days followed by 1-week break. This treatment was given to children with advance stage diseases (stage-IV), relapse cases and refractory cancer following treatments with the standard protocols available in our institution. Adverse events were determined through laboratory analyses and investigator observations.  Results: Total 21 children (median age- 4y; range, 6 m to14y) were included. Among 21 patients 2 patients lost to follow-up. 19 patients included in this study. The most frequent diagnoses were Neuroblastoma (14). At 8 weeks 13(68.42%) patients experienced disease stabilization and progressive disease 06(31.57%). 11(57.89%) patients achieved partial remission. Complete remission achieved 9(47.36%) patients at 28 weeks and 2(10.52%) patients up to last follow-up at 150weeks and continued their treatment for 37.5 months. After a median follow-up of 24 weeks (range:2-96wk) 8 patients (42%) were alive. During treatment period there were no significant complication only one patient developed mild neutropenia. No other moderate to severe toxicities were noted.  Conclusion: The MC that we used was safe, well tolerated and represents good value for patients with advance diseases that are eligible for palliative care. Children achieved disease stabilization, partial and complete remission without any complication. The use of MC in children in low and middle-income countries is safe and effect.

Keywords : Metronomic Chemotherapy, Low and Middle Income, Advanced Cancer, Children