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

Abstract

Background and Objective In general, there are not many studies exploring the clinical value of adjuvant chemotherapy or maintenance chemotherapy (AC/MC) after induction chemotherapy and concurrent chemoradiotherapy (IC+CCRT+AC/MC). The purpose of this study was to establish a clinical nomogram for the use of AC/MC in patients with locoregionally advanced nasopharyngeal carcinoma (LA‐NPC). Material and Methods Two centers (Guangzhou Medical University Cancer Center [ N = 1226] and Zhongshan People's Hospital [ N = 150]) recruited 1376 patients with LA‐NPC. All the patients underwent IC+CCRT; 560 patients received AC with cisplatin/nedaplatin plus docetaxel/paclitaxel (TP) or cisplatin/nedaplatin plus fluorouracil (PF), and 81 patients received MC with S‐1. Multivariate Cox regression was used to confirm optimal predictors of progression‐free survival (PFS), and a nomogram was established to identify patients into low‐risk and high‐risk cohorts. Additionally, bootstrap internal validation was performed to further verify our nomogram. Results After propensity score matching (PSM), the survival curves were not statistically different between IC+CCRT+AC/MC and IC+CCRT (all p > 0.05). Then, a nomogram was developed based on variables that were screened by univariate and multivariate Cox regression, including N stage, cumulative platinum dose during CCRT, body mass index (BMI), IC cycles, IC regimen and cervical lymph node (CLN) necrosis and infiltration of adjacent tissues. The results of the nomogram showed that the high‐risk cohort had greatly worse 5‐year DMFS, LRFS, PFS and OS compared to low‐risk cohort (all p < 0.05), and subgroup analysis found that the 5‐year DMFS, PFS and OS of patients treated with IC+CCRT+AC/MC were better than those treated with IC+CCRT in high‐risk cohort (all p < 0.05). Notably, the incidence of adverse effects for IC+CCRT+AC cohort was higher than that for IC+CCRT+MC cohort, especially leukocytopenia and neutropenia. IC+CCRT and IC+CCRT+MC were associated with similar incidences of adverse effects. Conclusions The addition of AC or MC to IC+CCRT could improve the DMFS of patients with high‐risk NPC and prolong their survival. Additionally, our findings suggest a potential role of AC/MC following IC plus CCRT in the treatment of high‐risk LA‐NPC.

Metronomic S-1 Adjuvant Chemotherapy Improves Survival in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

“…In patients with advanced NPC or LANPC, S1 maintenance therapy as a conventional treatment also has been found to improve survival outcomes of patients [16][17][18][19][20]. However, there were approximately 40% of patients were unable to complete the recommended treatment cycle or required dose adjustment [16][17][18][19][20]. In our study, all patients completed one year of metronomic S1, and only 12.5% of patients had dose adjustment.…”

“…widely used chemotherapy agent for the treatment of gastrointestinal malignancies. In those with advanced NPC or LANPC, S1 maintenance therapy as a conventional treatment also has been found to improve survival outcomes of patients [16][17][18][19][20]. However, approximately 40% of patients were unable to complete the recommended treatment cycle or require dose adjustment.…”

“…In head and neck cancers, several studies have shown that the administration of conventional chemotherapy or MC with S1 was associated with better survival outcomes [30,31]. In patients with advanced NPC or LANPC, S1 maintenance therapy as a conventional treatment also has been found to improve survival outcomes of patients [16][17][18][19][20]. However, there were approximately 40% of patients were unable to complete the recommended treatment cycle or required dose adjustment [16][17][18][19][20].…”

“…In addition, only 74% of patients completed one year of capecitabine. The using of AC with S1 in NPC or head and neck cancers also showed a treatment completion rate was approximately 60% [16][17][18][19][20]31]. In those with head and neck cancers, Furusaka et al found…”