Modified bi‐weekly cetuximab‐cisplatin and 5‐FU/leucovorin based regimen for effective treatment of recurrent/metastatic head and neck squamous cell carcinoma to reduce chemotherapy exposure of patients

Abstract

Abstract Background The standard chemotherapy treatment protocol for patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) requires as long as 56 days of hospitalization over six months. Where the 5‐Fluorouracil (5‐FU) pump is available, most treatment will be on outpatient bases, however patients will still be under chemotherapy treatment for a comparable period of time (around 50 days). Aim A modified protocol was assessed to decrease hospitalization and/or chemotherapy treatment time without sacrificing outcomes, to potentially increase patient quality of life. Methods and results A retrospective analysis (2005–2018) of recurrent/metastatic HNSCC patients with a modified treatment protocol was performed. Treatment consisted of cisplatin, cetuximab, 5‐fluorouracil bolus and leucovorin administered on day 1 of a 2‐week cycle, and a continuous infusion of 5‐fluorouracil on days 1–2 of the cycle. Outcomes were measured by progression‐free survival, overall survival, and patient hospitalization time. Analysis was done using the Kaplan–Meier survival function curve. The study cohort consisted of 27 patients. The modified treatment protocol resulted in a median progression‐free survival of nine months and median overall survival of 14 months, while hospitalization time was reduced by almost 80% in the first six months of treatment. Conclusions Modification of the cisplatin, cetuximab, 5‐FU and leucovorin protocol to a bi‐weekly regimen utilizing alternative drug delivery methods, significantly reduced patient hospitalization from 56 days to 12 days in the first 6 months of treatment. This was achieved without compromising treatment outcome, while significantly reducing the days patients were exposed to chemotherapy, and thus potentially improving quality of life.

Keywords

• cetuximab
• cisplatin
• fluorouracil
• head and neck squamous cell carcinoma
• patient chemotherapy exposure