Head and Neck Cancers Coverage from Every Angle
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Triple Metronomic Chemotherapy for Platinum-Refractory Oral Cancer

By: Sarah Campen, PharmD
Posted: Wednesday, November 27, 2019

For patients with platinum-refractory oral cancer who experience treatment failure within 1 month of local therapy, treatment options are limited, and their prognosis is often poor. A phase I/II study published in the Journal of Clinical Oncology found that triple oral metronomic chemotherapy with erlotinib, methotrexate, and celecoxib for this patient population may prove to be an effective option.

“The [response rate] and median [progression-free survival] produced by the triple oral metronomic chemotherapy regimen, accompanied with a low rate of adverse events, is exciting and suggests its potential as an alternative treatment,” stated Vijay M. Patil, MBBS, MD, DM, of Tata Memorial Centre in Mumbai, India, and colleagues.

Participants in the trial had oral cavity squamous cell carcinoma that had progressed either within 1 month of surgery/radiation therapy or within 6 months of platinum-based systemic therapy. A total of 91 patients received erlotinib at 150 mg once daily, celecoxib at 200 mg twice daily, and methotrexate at 9 mg/m2 per week (the optimal biologic dose was determined in the phase I trial).

The median follow-up was 6.8 months.The response rate was 42.9%; the 3- and 6-month progression-free survival rates were 71.1% and 34.5%, respectively; and the 6-month overall survival rate was 61.2%. The mean Functional Assessment of Cancer Therapy–Head and Neck Trial Outcome Index score on day 8 was significantly improved by 6.1 units (P = .001), suggesting this palliative regimen improved quality of life.

Treatment was generally reported to be well tolerated. The most common any-grade adverse events were fatigue (85.2%), rash (80.7%), and anemia (80.7%); the most common grade 3 and 4 adverse events were hyponatremia (14.8%) and increased alanine aminotransferase levels (5.7%).

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

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