Palliative chemotherapy in head and neck squamous cell cancer - What is best in Indian population? A time without symptoms, treatment toxicity score based study

Abstract

Background:Patients with recurrent and metastatic head and neck Squamous Cell Cancer (HNSCC) have poor prognosis with limited treatment options. In view of decimal prognosis, the treatment decision should include quality of life (QOL) issues, cost-effectiveness besides the response rates and survival.Aim:Present retrospective analysis was conducted to evaluate efficacy (disease-free survival), pharmacoeconomics, and toxicity profile of four (4) different regimens, viz. gefitinib alone, gefitinib with methotrexate, methotrexate alone, or 5-FU with cisplatin.Materials and Methods:Case records between 2007 September and 2008 September were analyzed, 68 patients were found suitable for analysis. Patients received gefitinib (250 mg/day), methotrexate as 50 mg intramuscular weekly or a combination of the same or 5-FU 750 mg/m2/day for 4 days along with cisplatin 75 mg/m2/day on day 1 in 21-day cycle.Results:A total of 68 patients received therapy. Fifty-one patients have clinically meaningful response (stable disease + complete + partial responses) (75%) and had symptomatic improvement. The median progression-free survival was significantly superior in responders (those who achieved partial or complete response) (8.4 months vs. 3.1 months, P=0.001). Methotrexate with gefitinib had maximum median survival and better overall QOL compared to the other treatment regimens. Weekly methotrexate is relatively cost-effective followed by methotrexate with gefitinib and gefitinib alone. 5-FU with cisplatin in our experience does not appear so attractive in view of high complication rates (when given in full doses) and prolonged hospital stay.Conclusion:Based on the results of this retrospective analysis, methotrexate weekly as single agent or in combination with gefitinib appears as an attractive alternative regimen for patients with metastatic HNSCC including those having poor performance status. A prospective study was planned and submitted to the local ethics committee based on above results to validate these results and compare methotrexate and gefitinib arm with 5-FU + cisplatin.

Acute Stage Longitudinal Change of Quality of Life from Pre- to 3 Months after Surgical Treatment in Head and Neck Cancer Patients

“…It decreases the patient's quality of life (QOL) following HNC treatment (Kalyanam et al, 2018;Anuradha et al, 2013). QOL is considered to be an important factor in both treatment decision and outcome evaluation (Anuradha et al, 2013;Blazeby et al, 1995;Maciejewski et al, 2010;Gonçalves et al, 2012). Particularly, QOL is necessary in multidirectional analysis and appropriate evaluation of treatment results.…”

Initial experience of head and neck cancer patients treated in an oncologist led palliative cancer care clinic at a tertiary cancer care center in uttar pradesh: Is the initiative of a full-fledged palliative care for cancer patients justified

“…Our patient population was similar to other reports, i.e., predominantly male population and in the fourth/fifth decade of life. [ 5 7 9 ] We had nearly an equal proportion of de novo patients as well as radical treatment failed patients. Expectedly, pain was the predominant feature in these patients.…”

“…in 68 patients concluded that 75% patients had a meaningful clinical response which has further effect on symptom improvement with weekly methotrexate ± geftinib. [ 9 ] Other study by Banipal and Mahajan showed a very good clinical response with decrease in the tumor bulk by more than 50% in nearly 40% patients and further 40% has stable disease with weekly injection methotrexate. [ 14 ] A study by Patil et al .…”

“…with the use of weekly methotrexate by stabilization of symptoms with minimal toxicities, and at the same time, it is an economical treatment. [ 9 ] A study by Ghoshal et al . with “Quad Shot” also reported a decrease in pain score in 10 out of 15 patients.…”

Promoter Hypermethylation Profiling Identifies Subtypes of Head and Neck Cancer with Distinct Viral, Environmental, Genetic and Survival Characteristics

“…Consumptions of tobacco (smoking and chewing), alcohol and HPV infection are well-known risk factors toward the development and progression of head and neck squamous cell carcinoma (HNSCC) [ 2 , 3 ]. In India, HNSCC has profound smoking, betel quid and tobacco chewing profile and comparatively poor survival [ 4 – 6 ]. However, HPV positive (+) HNSCC had distinct risk profile and associated with a better survival compared to HPV negative (-) HNSCC [ 7 ].…”