Karolina Larsson: Metronomic chemotherapy – one of several treatment options for metastatic breast cancer
The results of Karolina Larsson's thesis show that metronomic chemotherapy is a good treatment option for selected patients with metastatic breast cancer. The research also shows that patient autonomy is strengthened when oncologists make their own values behind their treatment recommendations explicit.
KAROLINA LARSSON
Dissertation defense: 30 Januaryl 2026 (click for details)
Doctoral thesis: Metronomic chemotherapy and treatment selection in metastatic breast cancer
Research area: Oncology
Sahlgrenska Academy, The Institute of Clinical Sciences
Breast cancer, the most common cancer among women, is curable in 90 percent of cases, while average survival in metastatic disease is around three years. Metastatic breast cancer refers to cancer that has spread from the breast to the skeleton or internal organs and is considered incurable. Palliative treatment can reduce symptoms and prolong life. The cornerstones of treatment include endocrine therapy, chemotherapy, and targeted therapies – all associated with different side effects.
"The dilemma is that patients spend a large part of their remaining time undergoing treatment, which makes it crucial that side effects do not cause more suffering than the cancer symptoms themselves. In addition, there is a lack of comparative studies, making treatment choices uncertain," says Karolina Larsson, consultant oncologist at the Breast Centre at Sahlgrenska University Hospital and a doctoral student at the Institute of Clinical Sciences.
Metronomic treatment and the oncologist's treatment choice in focus
The aim of the thesis was to investigate the role of so-called metronomic treatment- chemotherapy given in continuous low doses in tablet form - in metastatic breast cancer. She has also studied how the treatment choice itself is made in the late phase of the disease, and oncologists' experience of the treatment choices they recommend to their patients.
In-depth dialogue between patient and oncologist increases autonomy
The findings show that many patients appreciate metronomic treatment because it is easy to manage and associated with mild side effects. This allows them to live a life that more closely resembles a normal life, despite having incurable cancer – something they value highly.
"At the same time, several patients express concern that the treatment may not be as effective as other options. We interpret this as a need for more in-depth discussions between patients and oncologists, in which different treatment alternatives are discussed more clearly."
Good treatment options for selected patients
The conclusions indicate that metronomic chemotherapy may be a good treatment option for selected patients, but that future research needs to determine the lowest effective dose for each individual chemotherapy drug, rather than using the broad concept of metronomic treatment, which includes several different agents.
"We also argue that patient self-determination, or autonomy, is strengthened when oncologists take responsibility for decision-making by being transparent about their own opinions and values that have influenced the treatment recommendation given to the patient."
What has been the most rewarding part of your doctoral project?
"The most rewarding aspect of my doctoral work has been the opportunity, as a clinician, to research a question that arose while treating patients. It has also been valuable to explore how a research question can be addressed using both quantitative and qualitative methods, thereby providing different types of answers."
Text: Susanne Lj Westergren