Mahesh Sultania1, Mohammed Imaduddin1, Suryanarayana S V Deo2, Madhabananda Kar1, Dillip K Muduly1, Sunil Kumar2, Atul Sharma3, Ashutosh Mishra2, Saroj K D Majumdar4, Amit K Adhya5, Dilip K Parida4. 1. Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, India. 2. Department of Surgical Oncology, Dr. B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Medical Oncology, Dr. B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India. 4. Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, India. 5. Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, India.
Abstract
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.
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.