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Increased therapeutic index using moderate dose methotrexate and leucovorin twice weekly vs. weekly high dose methotrexate‐leucovorin in patients with advanced squamous carcinoma of the head and neck: A safe new effective regimen
Author(s) -
Kirkwood John M.,
Canellos George P.,
Ervin Thomas J.,
Pitman Susan W.,
Weichselbaum Ralph,
Miller Daniel
Publication year - 1981
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19810515)47:10<2414::aid-cncr2820471016>3.0.co;2-w
Subject(s) - medicine , regimen , methotrexate , toxicity , nephrotoxicity , mucositis , gastroenterology , therapeutic index , chemotherapy , surgery , pharmacology , drug
A new intensive methotrexate regimen for the treatment of advanced squamous carcinoma of the head and neck is presented, employing twice‐weekly parenteral low‐moderate doses of methotrexate and a single parenteral dose of leucovorin 24 hours following methotrexate. Toxicity and therapeutic results in 20 patients treated with this regimen compare favorably with results of weekly high‐dose methotrexate‐leucovorin in 36 patients treated immediately before initiation of the new regimen. Moderate nephrotoxicity and mild gastrointestinal/mucosal toxicity were common to both, while myelotoxicity was rarely seen with the low dose regimen and was more frequent with the high‐dose regimen. Partial response was observed in 60% of patients treated on the intensive low‐moderate dose schedule, and 50% of patients previously untreated with methotrexate on the weekly high‐dose schedule. None of 12 patients previously failing low‐moderate doses of methotrexate responded to high doses administered in this trial. The characteristics of antitumor response with low‐moderate and high‐dose schedules were similar except for the median dose required to attain response (50 mg/m 2 vs. 3 g/m 2 ) and the lesser toxicity of intensive lower dose therapy with leucovorin.