# METRO PLUS (Tata Memorial Centre, Varanasi)

Source: https://onco.cc/trials/metro-plus-varanasi/  
OnCo record `metro-plus-varanasi` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding low-cost oral metronomic tablets to standard paclitaxel-carboplatin doubled median survival from 5 to 10 months in a randomised trial run in Varanasi.

## Summary

238 patients (119 per arm) with advanced unresectable head and neck cancer were randomised to paclitaxel-carboplatin plus oral metronomic chemotherapy or paclitaxel-carboplatin alone. Median overall survival was 10 months with the combination versus 5 months with chemotherapy alone (hazard ratio 0.54; 95% CI 0.41-0.72; P<0.001). Published in JCO Global Oncology in 2026 and framed by its authors as a trial addressing global cancer care equity, it extends the Tata Memorial metronomic programme to the Gangetic plain and to patients fit for platinum doublets.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-10
- Phase: 3
- Setting: Advanced unresectable head and neck cancer: paclitaxel-carboplatin with or without oral metronomic chemotherapy
- Sponsor: Tata Memorial Centre (Homi Bhabha Cancer Hospital and MPMMCC, Varanasi)
- Enrolled: 238
- Result: Median OS 10 vs 5 months, HR 0.54.
- Outcomes: Median overall survival: Paclitaxel-carboplatin + oral metronomic chemotherapy 10 months vs Paclitaxel-carboplatin 5 months, HR 0.54

## Sources

- Kapoor et al., JCO Global Oncology 2026: https://doi.org/10.1200/GO-25-00721

## Connected records

- cancers: [Buccal mucosa and gingivobuccal cancer (oral cancer in India)](https://onco.cc/cancers/buccal-mucosa-cancer/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Recurrent or metastatic head and neck squamous cell carcinoma](https://onco.cc/cancers/recurrent-metastatic-hnscc/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/)
- institutions: [Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi](https://onco.cc/institutions/homi-bhabha-cancer-hospital-varanasi/), [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/)
- trials: [Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)](https://onco.cc/trials/metronomic-vs-cisplatin-tmh/)
- people: [Akhil Kapoor](https://onco.cc/people/kapoor-akhil/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/)
- key papers: [Integrating Metronomic Therapy With Standard Chemotherapy in Advanced Unresectable Head and Neck Cancer: A Randomized Trial Addressing Global Cancer Care Equity (METRO PLUS)](https://onco.cc/key-papers/paper-kapoor-jco-glob-oncol/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/)

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