Identifying optimal candidates for induction chemotherapy among stage II–IVa nasopharyngeal carcinoma based on pretreatment Epstein–Barr virus DNA and nodal maximal standard uptake values of [¹⁸F]‐fluorodeoxyglucose positron emission tomography

Abstract

Objective This study aimed to select optimal candidates benefiting from the addition of induction chemotherapy (IC) to concurrent chemoradiotherapy (CCRT) in stage II–IVa nasopharyngeal carcinoma (NPC) based on Epstein–Barr virus (EBV) DNA and nodal maximal standardized uptake values (SUVmax‐N) of [ 18 F]‐fluorodeoxyglucose positron emission tomography. Patients and materials A total of 679 patients diagnosed with stage II–IVa (except N0) NPC were retrospectively included in this study. Overall survival was the primary endpoint. Survival differences between different groups were compared using the log‐rank test. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using a multivariable Cox proportional hazards model. Results Both high levels of EBV DNA (>1500 copies/mL) and SUVmax‐N (>12.3) indicated worse survival conditions. All patients were divided into low‐ and high‐risk groups based on these two biomarkers. The risk group was an independent prognostic factor in OS, progression‐free survival (PFS), and distant metastasis‐free survival (DMFS) (all p ‐values<0.05). The addition of IC to CCRT was associated with survival improvement in OS, PFS, and DMFS in high‐risk patients, while no survival difference was found between CCRT and IC+CCRT in low‐risk patients. Conclusions Our study can help clinicians select stage II–IVa NPC patients who benefit from IC, which is important in guiding individual treatment.

Survival impact of additional induction chemotherapy in nasopharyngeal carcinoma with chronic hepatitis B infection: a retrospective, bi-center study

“…Thus, recent studies emphasize selecting effective biomarkers to identify ideal candidates for IC. NPC patients with higher pre-treatment plasma EBV DNA level content reportedly benefit more from the IC administration (10), consistent with our data that the IC + CCRT group tended to have higher plasma EBV DNA loads. However, whether HBV infection is a prognostic factor for IC has not been widely investigated.…”

“…However, not all patients with NPC benefit from this therapy (7,8). Furthermore, considering the side effects, time, and economic cost of IC, many researchers have screened for biomarkers to optimize clinical decision-making (9)(10)(11)(12)(13)(14). Serological hepatitis B surface antigen (HBsAg) is an important indicator of hepatitis B virus (HBV) infection, but whether HBsAg can be used as a reference factor in the choice of IC remains unclear.…”

A Nomogram to Identify the Optimal Candidates for Induction Chemotherapy in Advanced N-Stage Nasopharyngeal Carcinoma

“…Our data showed that the addition of IC was associated with more acute toxicities, which is similar to previous studies. 10 , 13 In that case, there is an urgent need for a more comprehensive prognostic model to precisely predict patient clinical survival and guide individualized treatment based on risk stratification.…”

“…Our data showed that the addition of IC was associated with more acute toxicities, which is similar to previous studies. 10,13 In that Patients with a higher risk of treatment failure are generally considered to benefit more from additional IC. Several studies followed up on this experience and confirmed the benefit of IC in NPC patients with high risk through the prognostic models they built.…”

“…Also, it should be noted that not all patients with LANPC could benefit from the use of IC. [11][12][13] Thus, it is essential to identify the optimal candidates for IC to improve the management of LANPC. According to the American Joint Commission on Cancer (AJCC) classification, patients with NPC are classified as N0-N3.…”