title: Methotrexate, vinblastine, epidoxorubicin, and bleomycin as second-line chemotherapy for recurrent and/or metastatic squamous cell carcinoma of the head and neck.
abstract: Thirty evaluable patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck region previously treated with cisplatin-based chemotherapy were treated with a combination of methotrexate, vinblastine, epidoxorubicin, and bleomycin as second-line chemotherapy. Besides surgery and/or radiotherapy all patients had previously received chemotherapy as induction therapy or as palliation for recurrent disease. Only 20% of patients achieved a partial objective response with a mean duration of 5.6 months (range 3.2-6.2), and 30% of patients had a stabilization of disease with a mean duration of 4.2+ months (range 3.8-6.0). Patients who responded had rhinopharyngeal carcinoma, poorly differentiated histology, or they had not been previously treated with radiotherapy. All remaining patients (50%) progressed. Toxicity was significant with grade 3-4 leukopenia in 30% of cases, grade 2-3 mucositis in 40% of patients, and grade 2-3 vomiting in 43% of cases. In consideration of the dismal clinical results and of the significant toxicity recorded, we do not recommend to use this combination as second-line therapy in recurrent head and neck cancer. Further chemotherapy should be reserved to carefully selected cases with a reasonably high chance of response.
authors.affiliation: Chair of Chemotherapy, University of Palermo, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Gebbia
authors.forename: R
authors.initials: R
authors.lastname: Valenza
authors.forename: A
authors.initials: A
authors.lastname: Testa
authors.forename: N
authors.initials: N
authors.lastname: Borsellino
authors.forename: G
authors.initials: G
authors.lastname: Cannata
authors.forename: S
authors.initials: S
authors.lastname: Restivo
authors.forename: R
authors.initials: R
authors.lastname: Speciale
authors.forename: F
authors.initials: F
authors.lastname: Ingria
authors.forename: G
authors.initials: G
authors.lastname: Spadafora
authors.forename: N
authors.initials: N
authors.lastname: Gebbia
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage* / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015251:Epirubicin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D010166:Palliative Care; D012074:Remission Induction; D013280:Stomatitis / Q000139:chemically induced; D015996:Survival Rate; D014747:Vinblastine / Q000008:administration & dosage* / Q000009:adverse effects; D014839:Vomiting / Q000139:chemically induced
chemical_list: D001761:Bleomycin; D015251:Epirubicin; D014747:Vinblastine; D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate