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Role of metronomic therapy for advanced oral cancers and predictors of response: Multi-institutional feasibility
Mahesh Sultania1, Mohammed Imaduddin1, Suryanarayana S V Deo2
1Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, India.
Background:
In an era of targeted therapies, patients with cancer in resource-constraint countries continue to struggle to find affordable care.
Methods:
The present study is a multicenter prospective single-arm study. Patients with expected delay in surgery, unresectable or metastatic cancers, and patients not suitable for surgery or conventional chemotherapy were included. Oral methotrexate 15 mg/m2 once a week and oral celecoxib 200 mg twice daily was used for metronomic therapy.
Results:
At 8 weeks, a clinically complete response was seen in 2.5%, partial response in 46.6%, stable disease in 39.8%, and disease progression in 11%. Size less than 4 cm, alveolobuccal subsite, and well-differentiated histology were significantly associated with no disease progression.
Conclusion:
Constraint-adapted approach of using methotrexate and celecoxib is economical with good compliance, minimal toxicity, and good efficacy. It is feasible for use in diverse settings. Individualized selection of patients based on response predictors may maximize metronomic therapy's benefit.
Insights
Metronomic therapy using oral methotrexate and celecoxib offers an affordable and effective cancer treatment option for resource-limited settings. This approach shows good efficacy and compliance, with specific patient factors predicting better outcomes.
Area of Science:
- Oncology
- Pharmacology
Background:
- Targeted therapies for cancer are often inaccessible in resource-limited countries.
- Patients face significant challenges in affording cancer care globally.
Purpose of the Study:
- To evaluate the efficacy and feasibility of a constraint-adapted metronomic therapy regimen.
- To assess the safety and patient compliance of oral methotrexate and celecoxib in diverse settings.
Main Methods:
- A multicenter prospective single-arm study was conducted.
- Included patients with delayed surgery, unresectable, metastatic, or non-surgical/chemotherapy-eligible cancers.
- Administered oral methotrexate (15 mg/m² weekly) and oral celecoxib (200 mg twice daily).
Main Results:
- An 8-week evaluation showed a 2.5% complete response, 46.6% partial response, and 39.8% stable disease.
- Disease progression was observed in 11% of patients.
- Tumor size <4 cm, alveolobuccal subsite, and well-differentiated histology were linked to no progression.
Conclusions:
- Metronomic therapy with methotrexate and celecoxib is economical, feasible, and demonstrates good efficacy with minimal toxicity.
- This approach is suitable for diverse healthcare settings.
- Patient selection based on predictive factors can optimize treatment benefits.
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