Synergistic Potential of Methotrexate and Gefitinib: A Promising Palliative Approach for Advanced and Recurrent Head and Neck Cancers

Abstract

Introduction: Head and Neck Cancers (HNCs) in India account for 30% of all cancers, out of which 60-80% of patients present with advanced disease, leaving the patients with limited survival and poor Quality of Life (QoL). Poor nutritional conditions, advanced disease presentation, limited tolerance, and socio-economic constraints necessitate the development of appropriate and effective palliative treatment options that are also easily available. One such palliative approach has been explored, and its relevance and applicability are discussed here. Aim: To study the role of weekly intramuscular injection Methotrexate (MTX) along with oral Tablet Gefitinib in advanced unresectable, recurrent, or residual HNCs. Materials and Methods: A retrospective analysis of 50 patients was carried out in the Department of Radiation Oncology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India. All patients included had advanced HNC and were ineligible for curative treatment. All received weekly intramuscular injection MTX 40 mg/m2 and Tablet Gefitinib administered orally in a dose of 250 mg once daily. These patients were assessed for tumour response, acute toxicities, symptomatic relief, and median survival. All the data were recorded in Microsoft Excel and analysed using Statistical Package for Social Sciences (SPSS) software version 28.0. Results: This study included 50 patients (45 males, 5 females) with a mean±SD age of 49±8.8 years, all diagnosed with histologically confirmed squamous cell carcinoma, predominantly at stage 3 (six patients) and stage 4 (44 patients). Median survival was 5.9 months. According to RECIST (Response Evaluation Criteria in Solid Tumours) criteria, no complete responses were observed; 18 (36%) had a partial response, 21 (42%) had stable disease, and 11 (22%) had progressive disease. The treatment was well-tolerated, providing notable relief in pain and dysphagia symptoms. In terms of toxicity, grade-3 mucositis was observed in 10 patients, and none had grade-4. Grade-3-4 neutropenia and anaemia were seen in six and eight patients, respectively. Conclusion: The use of MTX and gefitinib combination in advanced HNCs has the potential to substantially alleviate pain, provide symptomatic relief concerning dysphagia and speech, and hence improve the overall QoL.

Keywords

• chemotherapy
• metronomic
• neoplasms
• squamous cell carcinoma
• upper aerodigestive tract neoplasms