Assessment of drug utilization patterns and associated survival outcomes in recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC): Insights from a resource-constrained set-up

BackgroundRecurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has a poor prognosis due to patient rigors, such as malnutrition, uncontrolled comorbidities, age, and performance status. Rapidly evolving treatment paradigms have led to multimodal pharmacotherapy. This study evaluates drug utilization patterns of chemotherapy regimens used in R/M HNSCC patients to optimize evidence-based recommendations.MethodsThis prospective observational study recruited histologically confirmed R/M HNSCC patients aged 18-80 years, with Eastern Cooperative Oncology Group performance status 0-2, treated with palliative intent over one year.ResultsThis drug utilization pattern study recruited 112 patients. The most common chemotherapy regimens (31.19%) were oral triple metronomic chemotherapy followed by low-dose nivolumab plus oral metronomic chemotherapy (27.5%), paclitaxel and carboplatin with triple metronomic chemotherapy (20.5%), and paclitaxel plus carboplatin (19.7%). The median progression-free survival was 9 months (95% CI, 8.5-10.2). Grade 3 adverse events occurred in less than 12% of patients. Full-dose immunotherapy-based combination regimens contribute significantly (81.91%) to the total cost.ConclusionSignificant incongruity exists between NCCN-recommended first-line therapies and resource-constrained setups. The pragmatic use of cost-effective regimens, such as triple metronomic chemotherapy with low-dose nivolumab or as monotherapy, improves survival outcomes, thus optimizing patient care in real-world settings.