Sequential combination chemotherapy for advanced, recurrent, squamous carcinoma of the head and neck

Squamous carcinoma of the head and neck is a problem commonly seen by the chemotherapist in regional cancer centers, usually after surgical and/or radiation therapy have been used to their fullest extent with ultimate failure to control the disease. In the current study, sequential combined drugs were employed in an attempt to achieve three major goals: (a) delay the development of clinically evident drug resistance and thus prolong responses; (b) make use of the most effective single agent, methotrexate, which is difficult to use in concert with other stomatitis producing agents like bleomycin and adriamycin; and (c) reduce morbidity and mortality related to treatment. It is important to emphasize that in this regimen, in order to attempt to delay drug resistance, the switch to the next part of the program was made at fixed predetermined intervals and did not require that advancing disease develop in the patient for the change to occur (although if early progression occurred, we did make the switch prematurely). A total of 28 patients with advanced, recurrent, squamous carcinoma of the head and neck who had received no prior chemotherapy were treated.