Long term outcomes of phase I/II study of palliative triple metronomic chemotherapy in platinum-refractory/early failure oral cancer

Metronomic Chemotherapy in Oral Cancer: A Review

“…Methotrexate acts by inhibiting dihydrofolate reductase leading to DNA breakage [ 6 ]. This MC offered enhanced efficiency, better tolerance, and minimal grade adverse events in comparison to cisplatin, even as palliative therapy [ 1 ].…”

“…Patil et al also showed a significant improvement in overall survival with metronomic therapy when compared with IV cisplatin [ 14 ]. But, literature also shows that pembrolizumab, cetuximab, lapatinib, afatinib, and avelumab did not improve disease-free survival [ 1 , 6 ].…”

“…Dhumal et al administered triple MC with erlotinib 150 mg once daily, celecoxib 200 mg twice daily, and methotrexate weekly (phase 1 in variable dose 15-6 mg/m2 and 9 mg/m2 in phase 2) on 91 patients with platinum-refractory/early failure oral cancers. They reported 84 death events and the long-term outcome was unsatisfactory [ 1 ]. Nv et al have used methotrexate and erlotinib with a clinically meaningful response rate of 69% [ 1 ].…”

“…Oral cancer patients in India often present at advanced stages. Even after surgical resection and chemo-radiotherapy, 50% of such patients exhibit loco-regional recurrence and distant metastasis within 24 months [ 1 ]. Laskar et al have reported that 60% of 900 patients showed loco-regional recurrence even after post-surgery radiotherapy [ 2 ].…”

“…Laskar et al have reported that 60% of 900 patients showed loco-regional recurrence even after post-surgery radiotherapy [ 2 ]. Immunotherapeutic agents like nivolumab and targeted therapy like cetuximab have shown increased long-term survival but are not affordable in lower-income countries [ 1 , 3 ].…”