A platform trial of very-low-cost metronomic chemotherapy in LMIC common cancers
Frequent tiny doses of cheap old chemotherapy pills have shown surprising benefit in some cancers. A single large trial network in India and Africa could find out where this works and where it does not.
Metronomic regimens (low-dose oral methotrexate, cyclophosphamide, celecoxib) cost a few dollars a month and need no infusion. Tata Memorial trials showed a survival benefit for metronomic maintenance in head and neck cancer, but evidence in other tumours is thin and mostly single-centre. A multi-country platform trial with a shared control arm, adding and dropping regimens and tumour types, would generate definitive answers and could be run largely by nurses.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- No incentive to repurpose cheap drugs · Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.
- Trial design, endpoints and cost · A phase 3 trial takes years and hundreds of millions of dollars, and often answers a question that has already moved on.
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