Role of metronomic therapy for advanced oral cancers and predictors of response: Multi‐institutional feasibility study

• Published in: Head & neck 2022-01, Vol.44 (1), p.104-112
• Main Authors: Sultania, Mahesh, Imaduddin, Mohammed, Deo, Suryanarayana, Kar, Madhabananda, Muduly, Dillip, Kumar, Sunil, Sharma, Atul, Mishra, Ashutosh, Majumdar, Saroj, Adhya, Amit, Parida, Dilip
• Format: Article
• Language: English
• Subjects: administration; Antineoplastic Combined Chemotherapy Protocols; Celecoxib; Celecoxib - therapeutic use; Chemotherapy; Cyclophosphamide - therapeutic use; Feasibility Studies; Head & neck cancer; head and neck neoplasms; home care services; hospital‐based; Humans; Metastases; Methotrexate; metronomic; mouth neoplasms; Mouth Neoplasms - drug therapy; Oral cancer; palliative care; Patients; Prospective Studies; Surgery; Toxicity
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.26904

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.