A retrospective analysis of outcome with triplet oral metronomic chemotherapy in head and neck cancers in a resource comprising setting during COVID 19 pandemic, a single institute experience

Abstract

Introduction: The aim of this study was to assess the OS and toxicity of triplet oral triplet metronomic chemotherapy in patients with advanced / recurrent head and neck squamous cell carcinoma (HNSCC). Oral metronomic chemotherapy (OMCT) is regular administration of the chemotherapeutic drugs resulting in constant low blood level of the drug. It is economical and patient friendly especially in low resource setting. Materials and Methods: This is a retrospective study Conducted over a period of 3 years during COVID 19 pandemic in a resource poor district in India with no Radiation facility. The study participants include histologically confirmed head and neck tumours who are either not willing for a radical approach or palliative iv chemotherapy due to logistic and poor social support or not fit for the same. Patients received erlotinib 150 mg/100mg per oral once daily, capsule celecoxib 200 mg (Fixed dose) per oral twice daily and oral weekly methotrexate 9mg/m2. All the Statistical analysis were done using SPSS software version 16. Descriptive and Kaplan Meir Analysis were also performed. Result: A total of 211 patients were recruited over a period of 3 years from 2021. The median age was 51 with major site being Buccal mucosa .87 percent were having a stage IV disease. The majority had an ECOG PS status of 1-2 and 72 % were having a primary disease.90 % of them received a palliative RT from elsewhere. Only 10 % developed TKI toxicity and less than 10 % developed any other toxicities including hematological toxicities. Less than 20 % needed any IP admissions. The major cause of death was due to Aspiration pneumonia. CR was achieved in 19 % and Partial response was achieved in 39 % of patients. The median follow up was 11 months (95% CI 9.65-12.35). The 2 year survival rate is 65 %. Mean Survival time is 33.9 months (95 % CI 30.44 - 37. 40). Univariate and multivariate analysis showed only CR/PR had a significant impact on OS with HR 0.08 (95 % CI 0.04-0.17) and p value