Assessment of Quality of Life in Recurrent and Metastatic Head and Neck Cancer after Oral Metronomic Chemotherapy: A Prospective Interventional Study

Abstract

Introduction: Most of the Recurrent or Metastatic (R/M) Head and Neck Squamous Cell Carcinomas (HNSCC) patients are treated only by palliative treatment. Metronomic Chemotherapy (MC) low doses is an emerging therapeutic option in these patients. It exerts tumour angiogenesis, stimulate anticancer immune response, induces tumour dormancy and offers a significant improvement in Quality of Life (QoL) with minimal toxicity. Aim: To assess the changes in QoL in patients with Metastatic, Recurrent (M/R) HNSCC receiving MC. Materials and Methods: This was a prospective interventional hospital-based study from February 2015 to September 2018, conducted at Cancer Research Institute, Himalayan Institute of Medical Sciences, SRHU University, Dehradun, Uttarakhand, India. A total of 175 patients more than 18 years, with Eastern Cooperative Oncology Group (ECOG) performance status score <2, with M/R HNSCC, not amenable to any radical treatment, were equally distributed by lottery method in three arms, in those receiving Capecitabine (Arm A, n: 59), Celecoxib and Methotrexate (Arm B, n: 62); and placebo with best supportive care (Arm C, n: 54). In addition to demographic and baseline clinical characteristics, patients were assessed for physical examination and questioned to score their QoL by European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) at presentation and followed every month for two months. Results: A total of 175 patients enrolled for the study, the mean age of study population was 56.73±6.84 years with male preponderance 77.71%. A 60% suffered from carcinoma oral cavity (n=105), followed by carcinoma oropharynx (24%) (n=42), carcinoma larynx and carcinoma hypopharynx consisted rest 16% (n=28). Altogether the QoL was quite divergent amongst the three arms. Symptom score for fatigue, dyspnoea, loss of appetite, nausea and vomiting showed rise representing worsening in Arm A and Arm C; whilst these symptoms also showed fall in symptom score in Arm B (fatigue: p-value=0.007; dyspnoea; p-value=0.042; Appetite loss: p-value=0.008 Nausea: p-value=0.02; Vomiting: p-value=0.03). There was a statistically significant improvement in overall EORTC QLQ-C30 score from baseline in the Methotrexate and Celecoxib arm (Arm B) compared with Capecitabine and with placebo. Conclusion: Metronomic Chemotherapy (MC) with Methotrexate and Celecoxib seems promising and well tolerated in patients with metastatic or advanced HNSCC as compared to Capecitabine or keeping on symptomatic treatment solely.