{"entity":{"id":"metro-plus-varanasi","kind":"trial","name":"METRO PLUS (Tata Memorial Centre, Varanasi)","aka":[],"tldr":"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.","status":"positive","asOf":"2026-09-10","links":[{"label":"Kapoor et al., JCO Global Oncology 2026","url":"https://doi.org/10.1200/GO-25-00721"}],"tags":[],"related":[],"cancers":["head-and-neck","recurrent-metastatic-hnscc","buccal-mucosa-cancer"],"sections":[],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":["paclitaxel","carboplatin","methotrexate"],"companies":[],"institutions":["homi-bhabha-cancer-hospital-varanasi","tata-memorial"],"pathways":[],"terms":[],"trials":["metronomic-vs-cisplatin-tmh"],"people":["kapoor-akhil"],"bottlenecks":["b-generic-repurposing","b-global-access"],"keyPapers":["paper-kapoor-jco-glob-oncol"],"journals":[],"dependsOn":[],"notes":[],"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)","result":"Median OS 10 vs 5 months, HR 0.54.","yearReported":2026,"enrolled":238,"enrolledBasis":"registry","outcomes":[{"endpoint":"Median overall survival","primary":true,"unit":"months","arms":[{"name":"Paclitaxel-carboplatin + oral metronomic chemotherapy","n":119,"value":10},{"name":"Paclitaxel-carboplatin","n":119,"value":5}],"hr":0.54,"ci":[0.41,0.72],"p":"<0.001","source":"https://doi.org/10.1200/GO-25-00721"}]},"route":"/trials/metro-plus-varanasi/","neighbours":{"cancer":[{"id":"buccal-mucosa-cancer","kind":"cancer","name":"Buccal mucosa and gingivobuccal cancer (oral cancer in India)","route":"/cancers/buccal-mucosa-cancer/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"recurrent-metastatic-hnscc","kind":"cancer","name":"Recurrent or metastatic head and neck squamous cell carcinoma","route":"/cancers/recurrent-metastatic-hnscc/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"drug":[{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"},{"id":"paclitaxel","kind":"drug","name":"Paclitaxel / nab-paclitaxel","route":"/drugs/paclitaxel/"}],"institution":[{"id":"homi-bhabha-cancer-hospital-varanasi","kind":"institution","name":"Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi","route":"/institutions/homi-bhabha-cancer-hospital-varanasi/"},{"id":"tata-memorial","kind":"institution","name":"Tata Memorial Centre","route":"/institutions/tata-memorial/"}],"trial":[{"id":"metronomic-vs-cisplatin-tmh","kind":"trial","name":"Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)","route":"/trials/metronomic-vs-cisplatin-tmh/"}],"person":[{"id":"kapoor-akhil","kind":"person","name":"Akhil Kapoor","route":"/people/kapoor-akhil/"}],"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/"}],"paper":[{"id":"paper-kapoor-jco-glob-oncol","kind":"paper","name":"Integrating Metronomic Therapy With Standard Chemotherapy in Advanced Unresectable Head and Neck Cancer: A Randomized Trial Addressing Global Cancer Care Equity (METRO PLUS)","route":"/key-papers/paper-kapoor-jco-glob-oncol/"}],"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/"}]}}