EFFICACY OF METHOTREXATE IN THE MANAGEMENT OF LOCALLY ADVANCED AND METASTATIC HEAD AND NECK CANCERS

Abstract

Objective: To evaluate the efficacy of single agent methotrexate in locally advanced and metastatic head and neck cancer.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Oncology, Combined Military Hospital (CMH), Rawalpindi from Jan 2017 to Jul 2017.

Methodology: Fifty patients were enrolled with locally advanced or metastatic head and neck cancers, which were unfit for further treatment with curative radical surgery, radiotherapy and/or double agent chemotherapy. All the patients were treated with metronomic chemotherapy methotrexate 50mg weekly intravenously and the dose was escalated as tolerated up to a maximum of 200mg/week. Patients were followed up fortnightly for clinical response using Response Evaluation Criteria in Solid Tumors (RECIST). Imaging was performed on suspicion of progression.

Results: Out of 50 patients, two (4%) patients have shown complete clinical response, 16 (32%) patient with partial response and 19 (38%) patients with stable disease. Disease progression was observed in 13 (26%) patients. Subset analyses revealed thirty-two (64%) patients with improvement in quality of life in terms of symptomatic control. Only 9 (18%) patients were observed with Grade 2 neutropenia, 4 (8%) patients with grade 2 anemia.

Conclusion: Single agent methotrexate was an effective alternative regimen for patients with locally advanced or metastatic head and neck cancers.