Clinical Outcomes of Head and Neck Cancer Patients Treated with Palliative Oral Metronomic Chemotherapy at a Tertiary Cancer Center in Kerala, India.

BACKGROUND: Cetuximab-based chemotherapy is the standard palliative chemotherapy in head and neck cancers, but there is a limitation due to financial and logistic reasons, and where oral metronomic chemotherapy can be a successful alternate. Oral metronomic chemotherapy (MCT) can either be with Methotrexate alone or a combination of Methotrexate and Erlotinib. The study was aimed to assess the clinical outcome of oral MCT in head and neck cancer patients. MATERIALS AND METHODS: This was a retrospective review done at a tertiary cancer centre in India. The clinical outcomes of head and neck cancers patients started on palliative oral MCT from 1st August 2016 to 31st December 2017 were analyzed. The demographic details, toxicity profiles, response to MCT, disease progression status were analyzed. Univariate analysis was done to assess the factors associated with disease progression. Kaplan Meier curve was used for estimating progression free survival (PFS). RESULTS: Of the total 104 patients, the most common primary site of head and neck cancer was oral cavity (52%). MCT scheduled with Methotrexate and Erlotinib in 80 patients. Toxicity rate was 61%, with Grade 3-4 toxicity in 21%. Response rate was 56% and clinically meaningful response rate was 69%. Disease progression was observed in 55% patients. Median PFS rate was 134 Days. Oral MCT was permanently stopped in 73%, the most common reason being disease progression. DISCUSSION: Patients who underwent palliative oral MCT had a median PFS of 134 days which is considered as promising treatment method. Results confirmed more than 50% response rate with lower Grade 3-4 toxicities. CONCLUSION: Palliative oral MCT either with Methotrexate and Erlotinib or Methotrexate alone will be a feasible treatment option in patients with head and neck cancers treated with palliative intent.

Pain Management in Children With Cancer Using World Health Organization Guidelines at a Tertiary Cancer Center in Rural India.

Management of cancer pain among children is a difficult process due to the way they perceive pain, their dependence on parents, complexity of assessment, and limited availability of safe analgesics. Pain among children with cancer is still a less explored problem in India. This descriptive study was carried out in a tertiary cancer center to explore the characteristics of pain and its management among the children with cancer. We analyzed children diagnosed with hematologic malignancies, aged 4-18 years, admitted between January 2013 and December 2017. This retrospective cohort study involved the review of patient records available at the medical records department. During the study period, there were 290 admission episodes, of which 93 (32.1%) episodes were associated with pain. Of these 93 episodes, 14 (15%) were primarily for pain management. Step I analgesic was utilized in the majority (83%) of the admission episodes involving younger age group (4-9 years) children, whereas for the older age group (10-18 years) Step 2 analgesic (tramadol) was utilized in 29 (58%) episodes, and this was found to be statistically significant (P < .001). Only in 9 (9.7%) episodes Step 3 analgesic was utilized. A significant proportion of children with hematologic malignancies had pain episodes, and these episodes in older age group children were managed with weak opioids.