Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

Abstract

The role of induction chemotherapy in nasopharyngeal carcinoma (NPC) remains controversial. The primary aim of this study was to use the National Cancer Database to evaluate the patterns of care of induction chemotherapy in NPC and its impact on overall survival (OS). Patients with NPC from 2004 to 2014 were obtained from the NCDB. Patients were considered to have received induction chemotherapy if it was started ≥43 days before the start of RT and concurrent CRT if chemotherapy started within 21 days after the start of RT. Propensity score matching was used to control for selection bias. Cox proportional hazards model was used to determine significant predictors of OS. Logistic regression model was used to determine predictors of the use of induction chemotherapy. Significance was defined as a P value <.05. A total of 4857 patients were identified: 4041 patients (87.2%) received concurrent CRT and 816 patients (16.8%) received induction chemotherapy. The use of induction therapy remained stable between 2004 and 2014. Younger patients and those with higher T‐ and N‐stage had a higher likelihood of being treated with induction chemotherapy. The 5‐year OS in patients treated with induction chemotherapy and CRT was 66.3% vs 69.1%, respectively (P = .25). There was no difference in OS when these two groups were analyzed after propensity score matching. No differences in OS existed between these treatment groups in patients with T3‐T4N1 or TanyN2‐3 disease (P = .76). Propensity score matching also did not reveal any difference in OS in patients with T3‐T4N1 or TanyN2‐3 disease. The use of induction chemotherapy has remained stable in the last decade. In this study of patients with NPC, induction chemotherapy was not associated with improved OS compared to CRT alone.

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

“…When the role of IC was investigated in patients with different risk levels, we found that only high‐risk patients could benefit from the addition of IC. Although some researchers tried to identify the LANPC beneficial from IC therapy based on different prognostic factors, 20,21 the current study first verified that SUVmax‐N and EBV DNA could serve as a supplement to TNM staging to select candidates. Given that IC could result in excessive treatment toxicities, these biomarkers provided important information for individual treatment.…”

Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease

“…Therefore, additional chemotherapy with neoadjuvant treatment may contribute to increased survival rates in patients with keratinizing histology who tend to be more radioresistant. Our results differ from 2 recent NCBD publications that examined the effect of NAC on patients with NPC which found no association with survival . However, their limited analyses failed to examine specific high risk populations, particularly among patients with N3 disease as well as keratinizing histology.…”

Survival impact of treatment‐related time intervals in nasopharyngeal carcinoma in the United States

“…Because a majority of patients with NPC are treated with CCRT, this was the primary cohort of interest in the study. CCRT was defined as chemotherapy starting within 21 days after the start of RT . Patients who received other treatments, such as those receiving induction chemotherapy or radiation alone, were excluded from analysis (Fig.…”

“…Some centers prefer the use of induction chemotherapy (IC) as a neoadjuvant therapy before CCRT. However, at the time of this writing there is limited evidence indicating which modality is superior, as well as which particular cohorts would benefit from IC + CCRT versus CCRT+adjuvant CT . Recent studies have investigated whether several treatment‐related time intervals (TRTIs), such as time to radiation (TTR) and radiation duration (RTd), would impact survival in NPC patients.…”