Docetaxel and cisplatin induction chemotherapy with or without fluorouracil in locoregionally advanced nasopharyngeal carcinoma: A retrospective propensity score matching analysis

Abstract

Purpose: To investigate whether the addition of fluorouracil to docetaxel and cisplatin induction chemotherapy (IC) can truly improve the prognosis of patients with locoregionally advanced nasopharyngeal carcinoma (NPC).Methods: A total of 801 patients newly diagnosed with non-metastatic locoregionally advanced NPC were included as the subjects. In this study, propensity score matching (PSM) was used for analysis of overall survival (OS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and locoregional relapse-free survival (LRRFS), and the chi-squared test or Fisher's exact test was used to investigate toxic reactions.Results: Patients received treatment with docetaxel and cisplatin (TP) or docetaxel, cisplatin and fluorouracil (TPF). With a median follow-up time of 60 months (range: 5-124 months), the TPF group had better 5-year OS (84.7% vs 79.0%; P = 0.037), PFS (84.6% vs 76.8%; P = 0.008) and DMFS (89.5% vs 82.3%; P = 0.004) than the TP group. After PSM, 258 patients were matched in each cohort. The Kaplan-Meier analysis showed that the 5-year OS, PFS and DMFS were 85.5%, 84.2% and 89.2%, respectively, in the TPF group, higher than the 80.8%, 75.0% and 81.4%, respectively, in the TP group (P = 0.048, 0.009 and 0.006, respectively). Moreover, the multivariate analysis revealed that different IC regimens were independent prognostic factors for PFS and DMFS (P = 0.014 and 0.010, respectively). Conclusion:This study found that compared with the TP regimen, TPF induction chemotherapy is associated with improved survival in patients with locoregionally advanced NPC. TPF can produce more mucosal and nausea/vomiting adverse reactions than TP.

Efficacy of adjuvant chemotherapy/maintenance chemotherapy after induction chemotherapy and concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Experiences of two centers

“…Our research showed that patients who received one cycle of IC had worse survival outcomes than those who received two or more cycles. Recently, two clinical retrospective studies found that the TPF regimen led to better 5‐PFS and DMFS survival in LA‐NPC patients than the PF or TP regimen, which was similar to our finding 34,43 . In addition to IC cycles and IC regimens, many studies have shown that a cumulative dose of 200 mg/m 2 cisplatin is optimal for treating patients with LA‐NPC 44–46 .…”

“…Recently, two clinical retrospective studies found that the TPF regimen led to better 5‐PFS and DMFS survival in LA‐NPC patients than the PF or TP regimen, which was similar to our finding. 34 , 43 In addition to IC cycles and IC regimens, many studies have shown that a cumulative dose of 200 mg/m 2 cisplatin is optimal for treating patients with LA‐NPC. 44 , 45 , 46 However, the optimal cumulative dose of cisplatin during radiotherapy after IC remains controversial, so we still regarded 200 mg/m 2 as the critical dose.…”