When I was on standard Folfirinox from 2012-2014, I only required one administration of Neulasta to raise my WBC count. The 14 day Administration cycle of FFX was never impacted. My platelet counts fluctuated but never low enough to postpone chemo.

Normal rapidly dividing cells although affected by chemo are not impacted to the same degree as malignant cells. My reducing dosage and administering more frequently, the healthy rapidly dividing cell tropes are more robust while the malignant rapidly dividing cells are still sensitive to the toxicity of the drug.

It is interesting that using an antibiotic is more like the metronomic approach.You don’t get blasted with a massive bolus of an antibiotic. They use the Mean Inhibitory Concentration approach where you get a concentration of the minimum amount plus a little extra to be on the safe side to be bacterialcidal against the bacterial strain and at certain time points over the course of 1-2 weeks. Metronomic dosing is similar in this respect-enough of a concentration to kill malignant cells with less impact on healthy cells and easier on the patient.