Weekly methotrexate in squamous cell cancers of head and neck

Abstract

15539 Background: The aim was to evaluate response rates and toxicity of weekly methotrexate in locally advanced or recurrent squamous cell cancers of the head and neck region. Methotrexate, oldest non-platinum drugs active in squamous cell cancer of head and neck, was selected for its cost-effectiveness and ease of administration. Methods: Patients with locally advanced, inoperable or recurrent squamous cancers were selected. Sites included anterior two-third tongue, buccal mucosa, alveolus, base tongue, larynx and maxilla. Methotrexate 1 mg/Kg was given intramuscularly on outpatient basis once a week for 6 to 8 weeks along with hydration. Patients who responded well and became resectable were encouraged to undergo surgery. All patients were followed up in the clinic every monthly. Results: Total 19 patients were entered on the study over a duration of 24 months. 12 out of 19 patients had partial response (63%), 5 had stable disease (26%) and 2 patients had disease progression. Symptomatic relief ranged from 25% to 100%. Maximum response duration was 12 weeks. Treatment naïve patients had rapid response. In 5 patients disease became clearly resectable. Toxicity was grade II-III oral mucositis in patients with previous radiation. Sample size is small for a subset analysis. Conclusions: Weekly methotrexate is a simple, cost-effective regimen for palliation in advanced recurrent squamous cell cancers of head and neck region. It should also be evaluated further in large scale trials and especially in neo-adjuvant setting in locally advanced squamous cell cancers of the head and neck region given its rapidity of response and brief duration of therapy. No significant financial relationships to disclose.