[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-373764-105":59,"doc-detail-373764-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","optimizing-outcomes-the-role-of-oral-metronomic-therapy-in-proliferative-verrucous-leucoplakia","Optimizing outcomes - The role of oral metronomic therapy in proliferative verrucous leucoplakia","","Cancer prevention and improved patient prognosis drive interest in chemopreventive regimens, particularly metronomic chemotherapy (MCT). MCT delivers low-dose oral conventional drugs to maintain constant low blood concentrations, aiming for tumour dormancy and anti-angiogenesis while modulating immune responses by reducing regulatory T-cell activity and restoring NK and T-cell functions. Clinical and preclinical findings highlight use of oral MCT in multiple cancers and discuss proposed drugs such as celecoxib with methotrexate for proliferative verrucous leucoplakia (PVL), including reported case-series outcomes and ongoing needs to address tumour heterogeneity and field cancerization.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/optimizing-outcomes-the-role-of-oral-metronomic-therapy-in-proliferative-verrucous-leucoplakia/373764/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/optimizing-outcomes-the-role-of-oral-metronomic-therapy-in-proliferative-verrucous-leucoplakia/373764.png","ImageObject",300,407,{"name":92,"@type":93},"Bulrr","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is metronomic chemotherapy and how is it administered?","Question",{"text":112,"@type":113},"Metronomic chemotherapy uses low-dose conventional chemotherapy drugs given orally to maintain constant, low concentrations in blood at short intervals.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does oral metronomic therapy potentially work against tumors?",{"text":117,"@type":113},"It induces tumour dormancy and anti-angiogenesis, modulates innate immunity by reducing Treg response and restoring NK/T-cell functions, and alters the tumour microenvironment to reduce residual tumor growth.",{"name":119,"@type":110,"acceptedAnswer":120},"Why is proliferative verrucous leucoplakia (PVL) a key focus for this approach?",{"text":121,"@type":113},"PVL has the highest malignant transformation rate among oral potentially malignant disorders, and multifocal disease in PVL is linked to field cancerization; oral MCT is proposed to reduce progression and malignant transformation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},373764,1790763003,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39},5909892115043,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Short Communicat~~ion  ~~  \nOptimizing outcomes: The role of oral metronomic therapy in proliferative verrucous leucoplakia  \nDear Editor  \nCancer is the potentially fatal illness and remains the second greatest cause of death globally. Chemoprevention was first used 46 years ago as a means of preventing the development of cancer. The shortcomings of the anticancer treatment approaches currently in use emphasize, how critical it is to create more effective regimens to improve patient prognosis. [1] The word ‘metronomic’ is derived from the musical instrument ‘metronome’ that produces rhythmic metrical ticks representing a regular aural pulse. Metronomic chemotherapy (MCT) uses low‑dose conventional chemotherapy drugs via oral route for maintaining constant, but low concentrations in blood. Thus, the main idea is to frequently administer the optimal tolerated dose of the drug at a short interval. [2]  \nMCT primarily functions by means of inducing tumour dormancy and anti‑angiogenesis. [3,4] It modulates the innate immune response by selectively reducing Regulatory T cell (Treg) response and restoring natural killer (NK) cell and T cell functions. It alters the tumour microenvironment to prevent the growth of residual tumour cells and reduces cancer stem cell population thereby improving therapeutic outcomes [Figure 1] . [5,6] Recent clinical research on MCT,  \nhave shown its therapeutic potential in many types of cancer primarily lung, colorectal, prostate, gastric, breast, and pancreatic cancers. [7]  \nSeveral drugs including Celecoxib (200 mg) with Methotrexate (MTX; 15 mg), S‑1 (Tegafur, Gimeracil, Oteracil) therapy and others are proposed for oral MCT.[5] The ones commonly used in Indian subcontinent are a combination of Celecoxib and MTX. [8‑10]  \nCelecoxib, a highly selective cyclooxygenase‑2 (COX‑2) inhibitor, has less toxicity than traditional COX inhibitors. Clinically, 200 mg or 400 mg Celecoxib daily has been used to treat rheumatoid arthritis and other diseases, and the food and drug administration (FDA) has approved both doses. It has also been tested for prevention and control of oral carcinogenesis at an early stage of the disease. [11,12] Feng L et al.[12] in 2006, have shown that Celecoxib can be used as a chemo preventive drug for oral precancerous lesions and patients with risky prognosis.  \nMTX, an antimetabolite chemotherapeutic agent, is a folate antagonist which inhibits tumour growth by limiting the synthesis of purines and pyrimidines. MTX is effective and commonly used in the treatment head and neck cancers, acute lymphocytic leukaemia, non‑Hodgkin’s  \nFigure 1: Mechanism of action of the oral metronomic therapy  \n© 2025 Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer-Medknow 465  \nKheur, et al.: Oral metronomic therapy in PVL  \nlymphoma, choriocarcinoma, osteosarcoma, and breast cancer. [10,13,14] Oral formulations of MTX show about 35% bioavailability, which is significantly lower than the parenterally administered form (around 64%–90%) . [14] Kumar et al.[8] have shown newer formulations that can give better bioavailability and less degradation of the drug. Patilet al.[9] have used the regime of MTX 15 mg/m2/week and 200 mg celecoxibB.D based on disease progression and/or until the development of side effects. Besides its anticancer effect, MTX is also considered safe for the management of psoriasis, lupus, inflammatory bowel disease, and other connective tissue diseases. [14]  \nPROPOSED USE IN ORAL MULTIFOCAL/  \nPROLIFERATIVE VERRUCOUS LEUCOPLAKIA  \nOral cancer generally presents in form of precursor lesions known as the oral potentially malignant disorders (OPMD) . The malignant transformation rate of these OPMD changes over the spectrum of the presentation. Proliferative Verrucous leucoplakia (PVL) has the highest rate of malignant transformation (45.8%) and 46.5% of patients with malignant transformation showed progressive occurrence of carcinomas in different oral site","cbCaimONoppJuIwv","https://ap.wps.com/l/cbCaimONoppJuIwv","pdf",548961,"English","# Optimizing outcomes: The role of oral metronomic therapy in proliferative verrucous leucoplakia\n## Rationale for metronomic chemotherapy\n## Proposed use in oral proliferative verrucous leucoplakia","[{\"question\":\"What is metronomic chemotherapy and how is it administered?\",\"answer\":\"Metronomic chemotherapy uses low-dose conventional chemotherapy drugs given orally to maintain constant, low concentrations in blood at short intervals.\"},{\"question\":\"How does oral metronomic therapy potentially work against tumors?\",\"answer\":\"It induces tumour dormancy and anti-angiogenesis, modulates innate immunity by reducing Treg response and restoring NK/T-cell functions, and alters the tumour microenvironment to reduce residual tumor growth.\"},{\"question\":\"Why is proliferative verrucous leucoplakia (PVL) a key focus for this approach?\",\"answer\":\"PVL has the highest malignant transformation rate among oral potentially malignant disorders, and multifocal disease in PVL is linked to field cancerization; oral MCT is proposed to reduce progression and malignant transformation.\"}]","Optimizing outcomes - The role of oral metronomic therapy in proliferative verrucous leucoplakia | PDF",1790200392]