{"entity":{"id":"idea-acc-metronomic-lmic-platform-trial","kind":"idea","name":"A platform trial of very-low-cost metronomic chemotherapy in LMIC common cancers","aka":[],"tldr":"Frequent tiny doses of cheap old chemotherapy pills have shown surprising benefit in some cancers. A single large trial network in India and Africa could find out where this works and where it does not.","summary":"Metronomic regimens (low-dose oral methotrexate, cyclophosphamide, celecoxib) cost a few dollars a month and need no infusion. Tata Memorial trials showed a survival benefit for metronomic maintenance in head and neck cancer, but evidence in other tumours is thin and mostly single-centre. A multi-country platform trial with a shared control arm, adding and dropping regimens and tumour types, would generate definitive answers and could be run largely by nurses.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Most of the world has almost no cancer care): WHO fact sheet, Cancer","url":"https://www.who.int/news-room/fact-sheets/detail/cancer"}],"tags":[],"related":[],"cancers":["head-and-neck","cervical","tnbc"],"sections":[],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":[],"companies":[],"institutions":["tata-memorial"],"pathways":[],"terms":["basket-umbrella-platform"],"trials":[],"people":[],"bottlenecks":["b-global-access","b-generic-repurposing","b-trial-design"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"In at least two of five common LMIC tumour types, a metronomic regimen will improve overall survival over best supportive care or standard palliative chemotherapy at less than 5% of the drug cost.","rationale":"Head-and-neck results and the biology of anti-angiogenic and immunomodulatory low-dose schedules give a plausible mechanism; the drugs are on every essential medicines list.","test":"Run a phase 3 platform across the National Cancer Grid and African partner sites with overall survival and quality of life as endpoints, with pre-specified futility stopping per arm.","maturity":"early-clinical","actor":"research","cost":"medium","horizonYears":5},"route":"/ideas/idea-acc-metronomic-lmic-platform-trial/","neighbours":{"cancer":[{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"institution":[{"id":"tata-memorial","kind":"institution","name":"Tata Memorial Centre","route":"/institutions/tata-memorial/"}],"term":[{"id":"basket-umbrella-platform","kind":"term","name":"Basket, umbrella, and platform trials","route":"/terms/basket-umbrella-platform/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"global-access-roadmap","kind":"roadmap","name":"Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation","route":"/roadmaps/global-access-roadmap/"}]}}