Low dose sequential methotrexate and 5-fluorouracil administration is effective and safe as neo-adjuvant chemotherapy in oral cancer

We report on the effects and complications associated with low dose sequential methotrexate (MTX) and 5-fluorouracil (5-FU) (MF therapy) as neo-adjuvant chemotherapy in oral cancer. The oral cancer of 19 patients was treated as follows: MTX (75 mg/body) was administered by intravenous infusion for 1 hour, followed by 5-FU (500 mg/body) intravenous infusion for 2 hours, on Day 1, MTX (75 mg/body) intravenous infusion for 1 hour on Day 4, and parenteral dose of leucovorin on Day 2 and Day 5. A complete response was attained in one patient and a partial response in 11 patients. Complications observed were: increased serum transaminase levels (4), leucopenia (3), nausea or vomiting (4), anemia (1). The MF therapy of 2-8 courses was performed weekly or every 2 weeks. The volume in tumors of all cases decreased. Toxicity was extremely mild and radiotherapy or operation could be added sequentially without increased toxicity. These results suggests that MF therapy is effective and safety as neo-adjuvant chemotherapy before radiation and surgery for patients in oral cancer.