环磷酰胺和异环磷酰胺是主要的烷化剂，但由于多种毒性，它们的治疗用途受到限制。事实上，常规化疗通常使用最大耐受剂量。相比之下，节拍时间表的目的是获得最小剂量的疗效和良好的安全性。根据剂量的不同，它们的作用机制也不同，并具有双重活性：在高剂量时，环磷酰胺因其免疫抑制特性而主要用于移植物调理，而在节拍剂量时，它被用作免疫活性剂。目前，在节拍剂量下，环磷酰胺在临床上针对各种类型的癌症进行了研究，单独使用或与其他抗癌药物（抗血管生成剂、免疫调节剂、免疫检查点阻断剂、疫苗、放射治疗、其他常规抗癌剂）联合使用，例如n 线或一线治疗。超过四分之三的临床研究显示出有希望的结果，主要是针对乳腺癌、卵巢癌和前列腺癌。利用免疫系统，使用双重抗肿瘤作用的化疗显然是一种值得证实的治疗策略，以提高抗癌治疗的功效/毒性平衡，并使用CPM或类似物作为护理标准。版权所有©2024爱思唯尔 B.V. 出版

Cyclophosphamide and ifosfamide are major alkylating agents but their therapeutics uses are limiting by the toxicity due to several toxicities. Indeed conventional chemotherapies are generally used with the maximum tolerated dose. In contrast, metronomic schedule aims to get a minimum dose for efficacy with a good safety. Depending on the dose, their mechanisms of action are different and offer a dual activity: at high dose, cyclophosphamide is mainly used in graft conditioning for its immunosuppressive properties, while at metronomic dose it is used as an immunoactive agent. Currently, at metronomic dose, cyclophosphamide is studied in clinic against various types of cancer, alone or in combination with others anticancer drugs (anti-angiogenic, immune-modulating agents, immune checkpoints blockers, vaccines, radiotherapy, others conventional anticancer agents), as a nth-line or first-line treatment. More than three quarters of clinical studies show promising results, mostly in breast, ovarian and prostate cancers. Taking advantage of the immune system, use dual antitumor action's chemotherapy is clearly a therapeutic strategy that deserves to be confirmed in order to improve the efficacy/toxicity balance of anticancer treatments, and to use CPM or analogs as a standard of care.Copyright © 2024. Published by Elsevier B.V.