Validate low-cost metronomic oral regimens in phase 3 and carry them into guidelines
Indian trials have shown that tiny daily doses of old oral chemotherapy drugs can help patients with head and neck cancer at a cost of a few dollars a month. These regimens should be proven and adopted worldwide.
Tata Memorial Centre's randomised trials of low-dose oral metronomic chemotherapy (methotrexate plus celecoxib, later triple metronomic therapy) in head and neck cancer reported survival comparable or superior to intravenous cisplatin in palliative settings at a fraction of the cost, and low-dose nivolumab added to metronomic therapy improved survival in another trial. These results have had limited uptake outside India. The proposal is a coordinated programme of confirmatory phase 3 trials in several LMICs across common cancers (head and neck, cervical, breast), with an explicit path to WHO essential medicines listing and guideline inclusion.
- 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.
- 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.
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