Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)
Two cheap tablets taken at home matched, and in fact beat, intravenous cisplatin for advanced head and neck cancer in a 422-patient Indian trial, with fewer side effects.
Overview
An open-label non-inferiority phase 3 randomised 422 patients (213 oral metronomic, 209 cisplatin). Median overall survival was 7.5 months with oral metronomic chemotherapy versus 6.1 months with cisplatin (hazard ratio 0.773; 95% CI 0.615-0.97; P=0.026), meeting non-inferiority and favouring the oral regimen, with grade 3 or worse adverse events in 19% versus 30%. The authors noted that NCCN-recommended options apply to fewer than 3% of patients in low- and middle-income settings because of cost. The regimen became the backbone for the later low-dose nivolumab trial and for METRO PLUS.
- Median 7.5 vs 6.1 months with Oral metronomic (methotrexate + celecoxib) compared with IV cisplatin; about 1.4 months longer for half the group.
- A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
- Put another way, the treated group had about 23 percent lower chance of the event at any given time (hazard ratio 0.773, likely range 0.615 to 0.97).
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Recurrent, metastatic or inoperable head and neck carcinoma, palliative intent: oral methotrexate 15 mg/m2 weekly plus celecoxib 200 mg twice daily vs intravenous cisplatin. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
Pages like this
not linked directly; found by shared links- TrialLow-dose nivolumab plus metronomic chemotherapy (Tata Memorial)
Shares Vanita Noronha, Vijay Patil, Kumar Prabhash, Methotrexate.
- Key paperLow-dose immunotherapy in head and neck cancer: a randomised study (Tata Memorial)
Shares Vanita Noronha, Vijay Patil, Kumar Prabhash, Tata Memorial Centre.
- IdeaConfirm ultra-low-dose immunotherapy so it can be afforded where most patients live
Shares Vijay Patil, Kumar Prabhash, Tata Memorial Centre, Prices and value.
- TrialGefitinib vs gefitinib plus pemetrexed-carboplatin in EGFR-mutant lung cancer (Tata Memorial)
Shares Vanita Noronha, Kumar Prabhash, Tata Memorial Centre, Prices and value.
- PersonAkhil Kapoor
Shares METRO PLUS (Tata Memorial Centre, Varanasi), Methotrexate, Tata Memorial Centre, Cytotoxic chemotherapy.
- IdeaValidate low-cost metronomic oral regimens in phase 3 and carry them into guidelines
Shares Tata Memorial Centre, No incentive to repurpose cheap drugs, Most of the world has almost no cancer care, Cytotoxic chemotherapy.
- IdeaA platform trial of very-low-cost metronomic chemotherapy in LMIC common cancers
Shares Tata Memorial Centre, No incentive to repurpose cheap drugs, Most of the world has almost no cancer care, Cytotoxic chemotherapy.
- InstitutionHomi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi
Shares METRO PLUS (Tata Memorial Centre, Varanasi), Tata Memorial Centre, Most of the world has almost no cancer care, Cytotoxic chemotherapy.