​Outcome of Oral Metronomic Therapy with Methotrexate and Celecoxib in Advanced/ Recurrent Head and Neck Squamous Cell Carcinoma

ABSTRACT

Introduction: Metronomic chemotherapy (MC) is an emerging therapeutic option in clinical oncology and it may prove usefulat least in metastatic HNSCC patients. To develop rational therapeutic strategies, it is important to identify molecular targetsthat are linked to the pathogenesis of HNSCC.Aim: This study aims to assess the efficacy and toxicity of oral MC with methotrexate and celecoxib in the treatment of advanced/recurrent HNSCC.Methods: Patients who received MC for advanced/recurrent HNSCC were analyzed. The combination of weekly oral methotrexate5 mg twice daily for 2 days/week and oral celecoxib 200 mg twice daily was offered as MC. The efficacy was noted in terms ofclinical benefit rate (CBR), pain control, changes in quality of life (QOL), and median time to progression (TTP).Results: A total of 50 patients were included in this study. At the end of 6 months, 4 patients (8%) had partial response (PR), 28patients (56%) had stable disease (SD), and 18 patients (36%) had progressive disease. The CBR (complete response+PR+SD)was 64% at 6 months. The median TTP was 8 weeks. At the end of 6 months, 60% of patients were pain free. The most common(>20% of patients) treatment-related adverse events were nausea (22%), vomiting (22%), and mucositis (20%). 6 patients (12%)developed anorexia and 3 patients (6%) developed fatigue. Mean QOL scores were improved with this MC.Conclusion: Oral MC with methotrexate and celecoxib for patients with advanced/recurrent HNSCC was effective, well tolerated,provides good pain control, and improves QOL with least toxicity profile.