Cetuximab and methotrexate in recurrent or metastatic head and neck squamous cell carcinoma-A single institution analysis of 54 patients.

Abstract

Platinum-based chemotherapy is the standard of care treatment for patients with non-resectable, recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC).1 However, the toxicides of platinum must not be ignored. In reality, many patients with non-resectable R/M HNSCC cannot tolerate platinum-based chemotherapy due to their performance status (PS) and/or comorbidities. Methotrexate (MTX), a folate antimetabolite that inhibits DNA synthesis, repair and cellular replication, has shown a modest response rate (RR) of 10% while RR was 32% for ciplatin/5-FU in R/M HNSCC, although this was in exchange with significantly increased toxicides with dsplatin/5-FU compared to MTX (P = 0.001).2 Cetuximab (CTX) is a chimeric monoclonal antibody directed against the extracellular portion of the epidermal growth factor receptor (EGFR). CTX monotherapy has shown RR of 13% in R/M HNSCC post-platinum-failure.3 Both CTX and MTX have shown single-agent activity in non-resectable R/M HNSCC with favourable toxicity profiles. However, data on combination CTX/MTX are limited. The purpose of this study is to provide outcomes data on combination CTX/MTX in non-resectable R/M HNSCC patients.