Metformin Hydrochloride and Doxycycline, Alone or Together in Treating Patients with Head and Neck Squamous Cell Carcinoma That Can Be Removed by Surgery

Inclusion Criteria

• Diagnosis of head and neck squamous cell carcinoma that is either biopsy proven or suspected based on history, physical, and or radiographic findings, and who are planned for definitive resection of the tumor without the use of neoadjuvant chemotherapy or radiation therapy at Thomas Jefferson University Hospital (TJUH) are eligible to participate
• Patient must be able to swallow pills
• Patients with serum creatinine levels less than 1.5 mg/dL
• Women of childbearing potential must have a negative urine or blood pregnancy test within 14 days of study enrollment
• All subjects must be able to comprehend and sign a written informed consent document
• Eastern Cooperative Oncology Group (ECOG) performance status =< 1

Exclusion Criteria

• Subjects that do not have a baseline tumor specimen/biopsy prior to starting study medications * Tumor specimens do not need to be at Jefferson at time of eligibility determination; tumor specimens held at outside institutions should be requested for analysis of pre-treatment tumor vs post-treatment tumor
• Subjects who are pregnant or breastfeeding, or may become pregnant during metformin and doxycycline administration
• Received prior cancer therapy for the head and neck squamous cell carcinoma (HNSCC) that is being resected
• Subjects on metformin or doxycycline for any reason during the preceding 4 weeks
• Diabetic subjects that are managed by taking metformin or insulin
• Subjects who have received iodinated contrast dye must wait 12 hours prior to starting metformin; if a computed tomography (CT) scan with contrast is scheduled after screening and consent, the metformin cannot be taken until after the CT with contrast has been completed and they have waited 12 hours
• Patients with serum creatine >= 1.5 mg/dL
• Patients with history of lactic or any other metabolic acidosis
• Patients with history of congestive heart failure stage III or greater
• Patients scheduled for definitive cancer surgical resection less than 7 days from beginning of study drug administration or greater than 6 weeks from beginning of study drug administration
• Aspartate aminotransferase (AST) greater than 2.5 times the upper limit of normal
• Alanine aminotransferase (ALT) greater than 2.5 times the upper limit of normal
• Alkaline phosphatase (Alk Phos) greater than 2.5 times the upper limit of normal
• Total bilirubin greater than 2.5 times the upper limit of normal
• Patients who have a history of hepatic dysfunction or hepatic disease and normal liver function tests will be eligible to participate
• Patients with a current history (in the past 30 days) of heavy drinking which is defined in accordance with Center for Disease Control and Prevention (CDC) definition as more than 8 drinks per week for women and more than 15 drinks per week for men; a standard drink contains .6 ounces of pure alcohol; generally, this amount of pure alcohol is found in 12-ounces of beer, 8-ounces of malt liquor, 5-ounces of wine, 1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey); while on study, patients should limit their alcohol consumption to no more than 8 drinks per week for women and no more than 15 drinks per week for men
• Patient with prior allergic reaction to metformin, doxycycline, or any other tetracycline antibiotic in the past
• Patient is on medications that are contraindicated with metformin or doxycycline under current Food and Drug Administration (FDA) recommendations; the following is a list of medications identified as class D (consider therapy modification) when treatment with metformin or doxycycline is considered: * Class D: ** Bismuth Subsalicylate ** Cimetidine ** Iodinated contrast agents ** Somatropin