Mr Naushad Ahmad, a 40-year-old male came with complaints of swelling in left cheek on 7th April 2022. It was insidious in onset and gradually progressive. Due to ignorance and late presentation it became a very large fungating mass on left cheek. On further evaluation with biopsy it was found to be a squamous cell carcinoma, a buccal mucosa cancer, which was because of the habit of tobacco chewing that he had. He did not have the money to get very high dose chemotherapy and lot of advanced treatment options that are available for head and neck cancer. But it was not a hopeless situation. Since money was a constraint this patient was started on a treatment Metronomic chemotherapy, in which anti-cancer drugs are administered in very low dose than the maximum tolerated dose repetitively over a long period to treat cancer with fewer side effects. There are multiple studies on Metronomic chemotherapies and it is shown that it is comparable and in some cases better than IV chemotherapies. So, Naushad was put on Gefitinib Methotrexate and Celecoxib. Improvement was noticed in two weeks and tumour was shrunk by 50%. He is still on therapy and it is hoped that the tumour would shrink by 80- 90%, post which surgery and radiation could be planned for the patient.

Dr Manish Singhal
Senior Consultant
Medical Oncology