Clinical Benefits of Metronomic Chemotherapy in Platinum-Refractory, Recurrent, and Metastatic Head and Neck Squamous Cell Carcinoma

Background: Patients with platinum-refractory disease who experience early treatment failure of head and neck squamous cell carcinoma (HNSCC) exhibit a dismal prognosis. Metronomic chemotherapy is a promising treatment schedule in clinical practice for HNSCC. Oral metronomic chemotherapy with methot...

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Main Authors: Amira Elwan, Adel Bakry, Mohamed Eesa, Hoda Ismail, Mohamed Alnemr
Format: Article
Language:English
Published: Shiraz University of Medical Sciences 2025-01-01
Series:Middle East Journal of Cancer
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Online Access:https://mejc.sums.ac.ir/article_50154_c6c8ac1e15d4b896a7dcb4b23c0311e1.pdf
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author Amira Elwan
Adel Bakry
Mohamed Eesa
Hoda Ismail
Mohamed Alnemr
author_facet Amira Elwan
Adel Bakry
Mohamed Eesa
Hoda Ismail
Mohamed Alnemr
author_sort Amira Elwan
collection DOAJ
description Background: Patients with platinum-refractory disease who experience early treatment failure of head and neck squamous cell carcinoma (HNSCC) exhibit a dismal prognosis. Metronomic chemotherapy is a promising treatment schedule in clinical practice for HNSCC. Oral metronomic chemotherapy with methotrexate, celecoxib, and capecitabine regimens was effective because of overcoming drug resistance and antiangiogenesis effects. We aimed to improve treatment outcomes of recurrent, platinum–resistant, and metastatic HNSCC.Method: In this prospective clinical trial, 94 patients diagnosed with advanced/recurrent HNSCC were enrolled. Patients received triple therapy, including capecitabine, methotrexate, and celecoxib. The multidisciplinary team evaluated treatment toxicity, response, progression-free survival (PFS), and overall survival (OS). Kaplan Meier curve was used to show the survival/Wilcoxon signed-rank test.Results: The most common observable toxicity findings were grade 1 plus grade 2 fatigue in 49 (52.1%), oral mucositis in 40 patients (42.5%), and anemia in 37 patients (39.4%) in the absence of notified grade 3 or 4 toxicities. 20 patients out of 94 exhibited complete responses (CRs). One and two-year PFS rates were 16% and 11.7%; and one and two-year OS were 21.3% and 17 %, respectively. Two median years PFS was 4 months, and two median years OS was 8 months (SPSS 16.0 for Windows, Wilcoxon signed-rank test, P value ≤ 0.05 is significant).Conclusion: Capecitabine, methotrexate, and celecoxib combined chemotherapy are effective and tolerable in treating platinum-refractory, recurrent, and metastatic HNSCC with non-inferior clinical outcome results, especially in poor societies.
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spelling doaj-art-8e942f9df41648b6963347e467a95dcd2025-01-13T05:34:02ZengShiraz University of Medical SciencesMiddle East Journal of Cancer2008-67092008-66872025-01-011619910710.30476/mejc.2024.101525.203450154Clinical Benefits of Metronomic Chemotherapy in Platinum-Refractory, Recurrent, and Metastatic Head and Neck Squamous Cell CarcinomaAmira Elwan0Adel Bakry1Mohamed Eesa2Hoda Ismail3Mohamed Alnemr4Clinical Oncology Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptMedical Oncology Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptOtorhinolarngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptOtorhinolarngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptOtorhinolarngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptBackground: Patients with platinum-refractory disease who experience early treatment failure of head and neck squamous cell carcinoma (HNSCC) exhibit a dismal prognosis. Metronomic chemotherapy is a promising treatment schedule in clinical practice for HNSCC. Oral metronomic chemotherapy with methotrexate, celecoxib, and capecitabine regimens was effective because of overcoming drug resistance and antiangiogenesis effects. We aimed to improve treatment outcomes of recurrent, platinum–resistant, and metastatic HNSCC.Method: In this prospective clinical trial, 94 patients diagnosed with advanced/recurrent HNSCC were enrolled. Patients received triple therapy, including capecitabine, methotrexate, and celecoxib. The multidisciplinary team evaluated treatment toxicity, response, progression-free survival (PFS), and overall survival (OS). Kaplan Meier curve was used to show the survival/Wilcoxon signed-rank test.Results: The most common observable toxicity findings were grade 1 plus grade 2 fatigue in 49 (52.1%), oral mucositis in 40 patients (42.5%), and anemia in 37 patients (39.4%) in the absence of notified grade 3 or 4 toxicities. 20 patients out of 94 exhibited complete responses (CRs). One and two-year PFS rates were 16% and 11.7%; and one and two-year OS were 21.3% and 17 %, respectively. Two median years PFS was 4 months, and two median years OS was 8 months (SPSS 16.0 for Windows, Wilcoxon signed-rank test, P value ≤ 0.05 is significant).Conclusion: Capecitabine, methotrexate, and celecoxib combined chemotherapy are effective and tolerable in treating platinum-refractory, recurrent, and metastatic HNSCC with non-inferior clinical outcome results, especially in poor societies.https://mejc.sums.ac.ir/article_50154_c6c8ac1e15d4b896a7dcb4b23c0311e1.pdfsquamous cell carcinoma of head and neckrefractorymethotrexatecelecoxibmetronomic chemotherapy
spellingShingle Amira Elwan
Adel Bakry
Mohamed Eesa
Hoda Ismail
Mohamed Alnemr
Clinical Benefits of Metronomic Chemotherapy in Platinum-Refractory, Recurrent, and Metastatic Head and Neck Squamous Cell Carcinoma
Middle East Journal of Cancer
squamous cell carcinoma of head and neck
refractory
methotrexate
celecoxib
metronomic chemotherapy
title Clinical Benefits of Metronomic Chemotherapy in Platinum-Refractory, Recurrent, and Metastatic Head and Neck Squamous Cell Carcinoma
title_full Clinical Benefits of Metronomic Chemotherapy in Platinum-Refractory, Recurrent, and Metastatic Head and Neck Squamous Cell Carcinoma
title_fullStr Clinical Benefits of Metronomic Chemotherapy in Platinum-Refractory, Recurrent, and Metastatic Head and Neck Squamous Cell Carcinoma
title_full_unstemmed Clinical Benefits of Metronomic Chemotherapy in Platinum-Refractory, Recurrent, and Metastatic Head and Neck Squamous Cell Carcinoma
title_short Clinical Benefits of Metronomic Chemotherapy in Platinum-Refractory, Recurrent, and Metastatic Head and Neck Squamous Cell Carcinoma
title_sort clinical benefits of metronomic chemotherapy in platinum refractory recurrent and metastatic head and neck squamous cell carcinoma
topic squamous cell carcinoma of head and neck
refractory
methotrexate
celecoxib
metronomic chemotherapy
url https://mejc.sums.ac.ir/article_50154_c6c8ac1e15d4b896a7dcb4b23c0311e1.pdf
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