Cancer Patients Treated with Palliative Oral Metronomic Chemotherapy at a Tertiary Cancer Center in Kerala, India
2020
Background: Cetuximab-based chemotherapy is the
standard palliative chemotherapy in head and neck
cancers, but there is a limitation due to financial and logistic
reasons, and where oral metronomic chemotherapy can
be a successful alternate. Oral metronomic chemotherapy
(MCT) can either be with Methotrexate alone or a
combination of Methotrexate and Erlotinib. The study was
aimed to assess the clinical outcome of oral MCT in head
and neck cancer patients.
Materials and Methods: This was a retrospective review
done at a tertiary cancer centre in India. The clinical
outcomes of head and neck cancers patients started
on palliative oral MCT from 1st August 2016 to 31st
December 2017 were analyzed. The demographic details,
toxicity profiles, response to MCT, disease progression
status were analyzed. Univariate analysis was done to
assess the factors associated with disease progression.
Kaplan Meier curve was used for estimating progressionfree survival (PFS).
Results: Of the total 104 patients, the most common
primary site of head and neck cancer was oral cavity
(52%). MCT scheduled with Methotrexate and Erlotinib
in 80 patients. Toxicity rate was 61%, with Grade 3-4
toxicity in 21%. Response rate was 56% and clinically
meaningful response rate was 69%. Disease progression
was observed in 55% patients. Median PFS rate was 134
Days. Oral MCT was permanently stopped in 73%, the
most common reason being disease progression.
Discussion: Patients who underwent palliative oral MCT
had a median PFS of 134 days which is considered as
promising treatment method. Results confirmed more
than 50% response rate with lower Grade 3-4 toxicities.
Conclusion: Palliative oral MCT either with Methotrexate
and Erlotinib or Methotrexate alone will be a feasible
treatment option in patients with head and neck cancers
treated with palliative intent.
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