Neoadjuvant chemotherapy followed by concurrent chemoradiation for locoregionally advanced nasopharyngeal carcinoma

Interim results from 2 prospective phase 2 clinical trials

Authors

  • Lin Kong MD,

    Corresponding author
    1. Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, People's Republic of China
    • Corresponding author: Lin Kong, MD, Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai 200032, P.R. China; konglinj@gmail.com

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  • Chaosu Hu MD,

    1. Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, People's Republic of China
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  • Xiaoshuang Niu MD,

    1. Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, People's Republic of China
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  • Youwang Zhang MD,

    1. Department of Radiation Oncology, Fudan University, Shanghai Cancer Center, Shanghai, People's Republic of China
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  • Ye Guo MD,

    1. Department of Medical Oncology, Fudan University, Shanghai Cancer Center, Shanghai, People's Republic of China
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  • Ivan W. K. Tham MD,

    1. Department of Radiation Oncology, National University Cancer Institute, National University of Singapore, National University Health System, Republic of Singapore
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  • Jiade Jay Lu MD

    1. Department of Radiation Oncology, National University Cancer Institute, National University of Singapore, National University Health System, Republic of Singapore
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Abstract

BACKGROUND

The authors studied the efficacy of neoadjuvant chemotherapy, consisting of a taxane, cisplatin, and 5-fluorouracil (5-FU) (the TPF regimen) followed by concurrent chemoradiation, in 2 separately designed and synchronously executed phase 2 trials for stage III and IVA/IVB nasopharyngeal cancer (NPC).

METHODS

Patients with newly diagnosed NPC were accrued to 2 trials, 1 for patients with stage III disease and the other for patients with IVA/IVB disease. All patients received TPF (docetaxel 75 mg/m2, cisplatin 75 mg/m2, and 5-FU 2500 mg/m2 every 3 weeks for 3 cycles) followed by cisplatin 40 mg/m2 per week concurrently with either 3-dimentional conformal radiation therapy or intensity-modulated radiation therapy.

RESULTS

From January 2007 to July 2011, 52 eligible patients with stage III NPC and 64 eligible patients with nonmetastatic stage IV NPC were accrued. With a median follow-up of 32.9 months, the 3-year overall survival rates were 94.8% (95% confidence interval [CI], 87.6%-100%) and 90.2% (95% CI, 81.8%-98.6%) for the stage III NPC group and the IVA/IVB NPC group, respectively. The 3-year progression-free survival, distant metastasis-free survival, and local progression-free survival rates were 78.2% (95% CI, 64.6%-91.8%), 90.5% (95% CI, 79.7%-100%), and 93.9%(87.1%-100%), respectively, for patients with stage III NPC and 85.1% (95% CI, 75.1%-95.1%), 88% (95% CI, 78.6%-97.4%), and 100%, respectively, for patients with stage IVA/IVB NPC. The most common severe (grade 3/4) hematologic and nonhematologic adverse events were neutropenia (64 patients; 55.2%) and nausea/vomiting (23 patients; 19.8%).

CONCLUSIONS

Neoadjuvant TPF followed by concurrent chemoradiation was well tolerated and produced encouraging outcomes in patients with locally advanced NPC in this hypothesis-generating study. The authors concluded that randomized controlled trials are warranted to definitively confirm this aggressive and potentially efficacious strategy. Cancer 2013;119:4111–4118. © 2013 American Cancer Society.

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