capecitabine + cyclophosphamide + methotrexate + celecoxib

This low-dose metronomic (LDM) poly-chemotherapy regimen is a combination of four oral agents—capecitabine, cyclophosphamide, methotrexate, and celecoxib—investigated by HaEmek Medical Center in Israel. Specifically designed for patients with metastatic colorectal cancer who have progressed after standard treatments (including bevacizumab and EGFR inhibitors), the regimen utilizes daily, low-dose administration without planned breaks. This approach shifts the therapeutic focus from direct cytotoxicity (Maximal Tolerated Dose) to anti-angiogenic and immunomodulatory mechanisms. Methotrexate acts as a dihydrofolate reductase inhibitor, capecitabine as a prodrug for the thymidylate synthase inhibitor 5-fluorouracil, cyclophosphamide as a DNA alkylating agent, and celecoxib as a selective COX-2 inhibitor to reduce inflammation and potentially inhibit tumor angiogenesis.

Other names

Metronomic Poly-chemotherapy (HaEmek)Low Dose Metronomic RegimenLDM Regimen