An audit of the results of a triplet metronomic chemotherapy regimen incorporating a tyrosine kinase inhibitor in recurrent/metastatic head and neck cancers patients

Vijay M. Patil; Santam Chakraborty; T. K. Jithin; T. P. Sajith Babu; Satheesh Babu; Shiva Kumar; M. S. Biji; Atanu Bhattacharjee; Satheesan Balasubramanian

doi:10.4103/2278-330X.181624

View/Download PDF

Buy Reprints

PDF

Translate this page into:

METRONOMIC THERAPY IN HEAD AND NECK CANCERS : Original Article

05 (

); 048-051

doi:

10.4103/2278-330X.181624

An audit of the results of a triplet metronomic chemotherapy regimen incorporating a tyrosine kinase inhibitor in recurrent/metastatic head and neck cancers patients

Vijay M. Patil^1,, Santam Chakraborty², T. K. Jithin¹, T. P. Sajith Babu³, Satheesh Babu⁴, Shiva Kumar³, M. S. Biji⁵, Atanu Bhattacharjee⁶, Satheesan Balasubramanian³

1 Department of Clinical Hematology and Medical Oncology, Malabar Cancer Center, Kannur, Kerala

2 Department of Radiation Oncology, Malabar Cancer Center, Kannur, Kerala

3 Department of Surgical Oncology, Malabar Cancer Center, Kannur, Kerala

4 Department of Imageology, Malabar Cancer Center, Kannur, Kerala

5 Department of Cancer Palliative Medicine, Malabar Cancer Center, Kannur, Kerala

6 Division of Clinical Research and Biostatistics, Malabar Cancer Center, Kannur, Kerala

*Corresponding author: Dr. Vijay M. Patil. vijaypgi@gmail.com

Published: 2020-12-28

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Background: Addition of erlotinib to metronomic chemotherapy (MCT) may lead to further improvement in progression-free survival (PFS) and overall survival in head and neck cancers. The aim of this study was to study the PFS with MCT + erlotinib combination in our setting. Methods: A single-arm prospective observational study conducted at Malabar Cancer Center. Patients warranting palliative chemotherapy for head and neck cancers, having adequate organ function, not-affording cetuximab and not willing for intravenous chemotherapy were included in this study. Oral methotrexate (15 mg/m ² /week), oral celecoxib (200 mg twice daily), and erlotinib (150 mg once daily) were administered till the progression of the disease or till intolerable side-effects. Patients underwent toxicity (CTCAE version 4.02) and response (RECIST version 1.1) assessment every 30 days. Statistical analysis was performed using SPSS version 16 (IBM, New York, USA). Descriptive statistics and Kaplan-Meier analysis have been performed. Results: A total of 15 patients received MCT. The median age of these patients was 65 years (range: 48-80). The Eastern Cooperative Oncology Group Performance Status was 0-1 in seven patients (46.7%), while it was 2 in eight patients (53.3%). The primary sites of tumor were predominantly oral cavity, 11 (73.4%). Prior to MCT, treatment with palliative radiation therapy was given in 11 patients and curative treatment in two patients. The best response post-MCT was complete remission in two patients, partial remission in seven patients, stable disease in four patients, and progressive disease in two patients. The median estimated PFS was 148 days (95% confidence interval 95.47-200.52 days). For a median follow-up of 181 days, there were only three deaths. Grade 3-4 toxicity was seen in six patients (40%). Dose reduction was required in four patients (26.7%). Conclusion: The addition of erlotinib to an MCT schedule of methotrexate and celecoxib resulted in a promising PFS and should be tested in future studies.

Keywords

References

Dikshit R, Gupta PC, Ramasundarahettige C, Gajalakshmi V, Aleksandrowicz L, Badwe R, et al. Cancer mortality in India: A nationally representative survey. Lancet 2012;379:1807-16.
Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, Fan L, Li J, Chavarri-Guerra Y, et al. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol 2014;15:489-538.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
Kwok J, Langevin SM, Argiris A, Grandis JR, Gooding WE, Taioli E. The impact of health insurance status on the survival of patients with head and neck cancer. Cancer 2010;116:476-85.
André N, Banavali S, Snihur Y, Pasquier E. Has the time come for metronomics in low-income and middle-income countries? Lancet Oncol 2013;14:e239-48.
Patil V, Noronha V, Krishna V, Joshi A, Prabhash K. Oral metronomic chemotherapy in recurrent, metastatic and locally advanced head and neck cancers. Clin Oncol (R Coll Radiol) 2013;25:388.
Patil V, Noronha V, D′cruz AK, Banavali SD, Prabhash K. Metronomic chemotherapy in advanced oral cancers. J Cancer Res Ther 2012;8 Suppl 1:S106-10.
Patil VM, Noronha V, Banavali SD, Joshi A, Dhumal S, Arya S, et al. A phase II study comparing metronomic chemotherapy with chemotherapy (single-agent cisplatin), in patients with metastatic, relapsed, or inoperable squamous cell carcinoma of head and neck. J Clin Oncol 2014;32:5s. [Suppl; abstr 601]. Available from: http://www.meetinglibrary.asco.org/content/125716-144. [Last cited on 2014 Jun 30].
Thomas F, Rochaix P, Benlyazid A, Sarini J, Rives M, Lefebvre JL, et al. Pilot study of neoadjuvant treatment with erlotinib in nonmetastatic head and neck squamous cell carcinoma. Clin Cancer Res 2007;13:7086-92.
Altundag O, Altundag K, Boruban C, Silay YS. Cross-talk between cyclooxygenase-2 and epidermal growth factor receptor in non-small cell lung cancer. Lung Cancer 2005;49:429.
Chen Z, Zhang X, Li M, Wang Z, Wieand HS, Grandis JR, et al. Simultaneously targeting epidermal growth factor receptor tyrosine kinase and cyclooxygenase-2, an efficient approach to inhibition of squamous cell carcinoma of the head and neck. Clin Cancer Res 2004;10:5930-9.
Shin DM, Zhang H, Saba NF, Chen AY, Nannapaneni S, Amin AR, et al. Chemoprevention of head and neck cancer by simultaneous blocking of epidermal growth factor receptor and cyclooxygenase-2 signaling pathways: Preclinical and clinical studies. Clin Cancer Res 2013;19:1244-56.
Kao J, Genden EM, Chen CT, Rivera M, Tong CC, Misiukiewicz K, et al. Phase 1 trial of concurrent erlotinib, celecoxib, and reirradiation for recurrent head and neck cancer. Cancer 2011;117:3173-81.
Molina MA, Cheung MC, Perez EA, Byrne MM, Franceschi D, Moffat FL, et al. African American and poor patients have a dramatically worse prognosis for head and neck cancer: An examination of 20,915 patients. Cancer 2008;113:2797-806.
Collingridge D, Sullivan R. Affordable cancer care: Pipedream or achievable reality? Lancet Oncol 2014;15:257-8.
Ignacio DN, Griffin JJ, Daniel MG, Serlemitsos-Day MT, Lombardo FA, Alleyne TA. An evaluation of treatment strategies for head and neck cancer in an African American population. West Indian Med J 2013;62:504-9.
Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008;359:1116-27.
Brockstein BE. Management of recurrent head and neck cancer: Recent progress and future directions. Drugs 2011;71:1551-9.
Vermorken JB, Stöhlmacher-Williams J, Davidenko I, Licitra L, Winquist E, Villanueva C, et al. Cisplatin and fluorouracil with or without panitumumab in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (SPECTRUM): An open-label phase 3 randomised trial. Lancet Oncol 2013;14:697-710.
Mohanti BK, Umapathy H, Bahadur S, Thakar A, Pathy S. Short course palliative radiotherapy of 20 Gy in 5 fractions for advanced and incurable head and neck cancer: AIIMS study. Radiother Oncol 2004;71:275-80.
Das S, Thomas S, Pal SK, Isiah R, John S. Hypofractionated palliative radiotherapy in locally advanced inoperable head and neck cancer: CMC Vellore experience. Indian J Palliat Care 2013;19:93-8.
Ghoshal S, Chakraborty S, Moudgil N, Kaur M, Patel FD. Quad shot: A short but effective schedule for palliative radiation for head and neck carcinoma. Indian J Palliat Care 2009;15:137-40.
Marur S, D′Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: A virus-related cancer epidemic. Lancet Oncol 2010;11:781-9.
Shin DM, Glisson BS, Khuri FR, Lippman SM, Ginsberg L, Diaz E Jr., et al. Phase II study of induction chemotherapy with paclitaxel, ifosfamide, and carboplatin (TIC) for patients with locally advanced squamous cell carcinoma of the head and neck. Cancer 2002;95:322-30.
Thyss A, Schneider M, Santini J, Caldani C, Vallicioni J, Chauvel P, et al. Induction chemotherapy with cis-platinum and 5-fluorouracil for squamous cell carcinoma of the head and neck. Br J Cancer 1986;54:755-60.
Herman LC, Karrison T, Witt ME, Muller C, Stenson K, Blair EA, et al. Comparison of outcomes of locoregionally advanced oropharyngeal and non-oropharyngeal SCC over two decades. J Clin Oncol 2014;32:5s. [Suppl; abstr 6048]. Available from: http://www.meetinglibrary.asco.org/content/127643-144. [Last cited on 2014 Jun 30].

Fulltext Views
33

PDF downloads
4

View/Download PDF
Download Citations

BibTeX
RIS

Show Sections

[1] Dikshit R, Gupta PC, Ramasundarahettige C, Gajalakshmi V, Aleksandrowicz L, Badwe R, et al. Cancer mortality in India: A nationally representative survey. Lancet 2012;379:1807-16.

[2] Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, Fan L, Li J, Chavarri-Guerra Y, et al. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol 2014;15:489-538.

[3] Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.

[4] Kwok J, Langevin SM, Argiris A, Grandis JR, Gooding WE, Taioli E. The impact of health insurance status on the survival of patients with head and neck cancer. Cancer 2010;116:476-85.

[5] André N, Banavali S, Snihur Y, Pasquier E. Has the time come for metronomics in low-income and middle-income countries? Lancet Oncol 2013;14:e239-48.

[6] Patil V, Noronha V, Krishna V, Joshi A, Prabhash K. Oral metronomic chemotherapy in recurrent, metastatic and locally advanced head and neck cancers. Clin Oncol (R Coll Radiol) 2013;25:388.

[7] Patil V, Noronha V, D′cruz AK, Banavali SD, Prabhash K. Metronomic chemotherapy in advanced oral cancers. J Cancer Res Ther 2012;8 Suppl 1:S106-10.

[8] Patil VM, Noronha V, Banavali SD, Joshi A, Dhumal S, Arya S, et al. A phase II study comparing metronomic chemotherapy with chemotherapy (single-agent cisplatin), in patients with metastatic, relapsed, or inoperable squamous cell carcinoma of head and neck. J Clin Oncol 2014;32:5s. [Suppl; abstr 601]. Available from: http://www.meetinglibrary.asco.org/content/125716-144. [Last cited on 2014 Jun 30].

[9] Thomas F, Rochaix P, Benlyazid A, Sarini J, Rives M, Lefebvre JL, et al. Pilot study of neoadjuvant treatment with erlotinib in nonmetastatic head and neck squamous cell carcinoma. Clin Cancer Res 2007;13:7086-92.

[10] Altundag O, Altundag K, Boruban C, Silay YS. Cross-talk between cyclooxygenase-2 and epidermal growth factor receptor in non-small cell lung cancer. Lung Cancer 2005;49:429.

[11] Chen Z, Zhang X, Li M, Wang Z, Wieand HS, Grandis JR, et al. Simultaneously targeting epidermal growth factor receptor tyrosine kinase and cyclooxygenase-2, an efficient approach to inhibition of squamous cell carcinoma of the head and neck. Clin Cancer Res 2004;10:5930-9.

[12] Shin DM, Zhang H, Saba NF, Chen AY, Nannapaneni S, Amin AR, et al. Chemoprevention of head and neck cancer by simultaneous blocking of epidermal growth factor receptor and cyclooxygenase-2 signaling pathways: Preclinical and clinical studies. Clin Cancer Res 2013;19:1244-56.

[13] Kao J, Genden EM, Chen CT, Rivera M, Tong CC, Misiukiewicz K, et al. Phase 1 trial of concurrent erlotinib, celecoxib, and reirradiation for recurrent head and neck cancer. Cancer 2011;117:3173-81.

[14] Molina MA, Cheung MC, Perez EA, Byrne MM, Franceschi D, Moffat FL, et al. African American and poor patients have a dramatically worse prognosis for head and neck cancer: An examination of 20,915 patients. Cancer 2008;113:2797-806.

[15] Collingridge D, Sullivan R. Affordable cancer care: Pipedream or achievable reality? Lancet Oncol 2014;15:257-8.

[16] Ignacio DN, Griffin JJ, Daniel MG, Serlemitsos-Day MT, Lombardo FA, Alleyne TA. An evaluation of treatment strategies for head and neck cancer in an African American population. West Indian Med J 2013;62:504-9.

[17] Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008;359:1116-27.

[18] Brockstein BE. Management of recurrent head and neck cancer: Recent progress and future directions. Drugs 2011;71:1551-9.

[19] Vermorken JB, Stöhlmacher-Williams J, Davidenko I, Licitra L, Winquist E, Villanueva C, et al. Cisplatin and fluorouracil with or without panitumumab in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (SPECTRUM): An open-label phase 3 randomised trial. Lancet Oncol 2013;14:697-710.

[20] Mohanti BK, Umapathy H, Bahadur S, Thakar A, Pathy S. Short course palliative radiotherapy of 20 Gy in 5 fractions for advanced and incurable head and neck cancer: AIIMS study. Radiother Oncol 2004;71:275-80.

[21] Das S, Thomas S, Pal SK, Isiah R, John S. Hypofractionated palliative radiotherapy in locally advanced inoperable head and neck cancer: CMC Vellore experience. Indian J Palliat Care 2013;19:93-8.

[22] Ghoshal S, Chakraborty S, Moudgil N, Kaur M, Patel FD. Quad shot: A short but effective schedule for palliative radiation for head and neck carcinoma. Indian J Palliat Care 2009;15:137-40.

[23] Marur S, D′Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: A virus-related cancer epidemic. Lancet Oncol 2010;11:781-9.

[24] Shin DM, Glisson BS, Khuri FR, Lippman SM, Ginsberg L, Diaz E Jr., et al. Phase II study of induction chemotherapy with paclitaxel, ifosfamide, and carboplatin (TIC) for patients with locally advanced squamous cell carcinoma of the head and neck. Cancer 2002;95:322-30.

[25] Thyss A, Schneider M, Santini J, Caldani C, Vallicioni J, Chauvel P, et al. Induction chemotherapy with cis-platinum and 5-fluorouracil for squamous cell carcinoma of the head and neck. Br J Cancer 1986;54:755-60.

[26] Herman LC, Karrison T, Witt ME, Muller C, Stenson K, Blair EA, et al. Comparison of outcomes of locoregionally advanced oropharyngeal and non-oropharyngeal SCC over two decades. J Clin Oncol 2014;32:5s. [Suppl; abstr 6048]. Available from: http://www.meetinglibrary.asco.org/content/127643-144. [Last cited on 2014 Jun 30].

An audit of the results of a triplet metronomic chemotherapy regimen incorporating a tyrosine kinase inhibitor in recurrent/metastatic head and neck cancers patients

Abstract

Abstract

Keywords

References

Suggested read for related articles:

We value your privacy