Palliative low dose fortnightly methotrexate in oral cancer.

Dear Editor,

A recent report on a single center experience on “palliative low dose fortnightly methotrexate (MTX) in oral cancer” is very interesting. Chakraborty et al. reported “the fortnightly regimen of MTX was well-tolerated and showed a good clinical activity in this elderly cohort of patients with advanced oral cavity and oropharyngeal cancers.”[1] In fact, the effectiveness of palliative low dose fortnightly MTX has been mentioned in other cancers like prostate cancer.[2] Nevertheless, the side effect of using MTX has to be mentioned and well-evaluated. Several possible side effects including to gastrointestinal and hematological side effects should be systematically evaluated. Sometimes, only the early signs impending pancytopenia in MTX toxicity could be observed.[3] The good early sign is “cutaneous erosion,” which is not mentioned in the report by Chakraborty et al.[1] Finally, the use of additional supplementation to reduce the toxicity of metrotrexate like folic acid should be discussed.[4]