Induction Chemotherapy plus Concurrent Chemoradiotherapy in Endemic Nasopharyngeal Carcinoma: Individual Patient Data Pooled Analysis of Four Randomized Trials

Abstract

Because of the uneven geographic distribution and small number of randomized trials available, the value of additional induction chemotherapy (IC) to concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) remains controversial. This study performed an individual patient data (IPD) pooled analysis to better assess the precise role of IC + CCRT in locoregionally advanced NPC. Four randomized trials in endemic areas were identified, representing 1,193 patients; updated IPD were obtained. Progression-free survival (PFS) and overall survival (OS) were the primary and secondary endpoints, respectively. Median follow-up was 5.0 years. The HR for PFS was 0.70 [95% confidence interval (CI), 0.56-0.86; = 0.0009; 9.3% absolute benefit at 5 years] in favor of IC + CCRT versus CCRT alone. IC + CCRT also improved OS (HR = 0.75; 95% CI, 0.57-0.99; = 0.04) and reduced distant failure (HR = 0.68; 95% CI, 0.51-0.90; = 0.008). IC + CCRT had a tendency to improve locoregional control compared with CCRT alone (HR = 0.70; 95% CI, 0.48-1.01; = 0.06). There was no heterogeneity between trials in any analysis. No interactions between patient characteristics and treatment effects on PFS or OS were found. After adding two supplementary trials to provide a more comprehensive overview, the conclusions remained valid and were strengthened. In a supplementary Bayesian network analysis, no statistically significant differences in survival between different IC regimens were detected. This IPD pooled analysis demonstrates the superiority of additional IC over CCRT alone in locoregionally advanced NPC, with the survival benefit mainly associated with improved distant control. .

Circular RNA CRIM1 functions as a ceRNA to promote nasopharyngeal carcinoma metastasis and docetaxel chemoresistance through upregulating FOXQ1

“…Increasing evidence suggests that systemic induction chemotherapy (IC) can effectively eliminate NPC micrometastasis and ultimately improve patient survival [18][19][20]. However, the responses to chemotherapy are heterogeneous, and some patients can develop resistance, leading to treatment failure [20].…”

Stratification of Candidates for Induction Chemotherapy in Stage III-IV Nasopharyngeal Carcinoma: A Large Cohort Study Based on a Comprehensive Prognostic Model

“…By lowering tumor volume and restricting occult micrometastasis, induction chemotherapy (IC) before RT has been proposed to further decrease distant metastasis risk. Previous studies have shown that IC might improve survival outcomes in patients with locoregionally advanced NPC (7,8). Nevertheless, not all patients with locoregionally advanced NPC benefit from IC.…”

Elevated EGFL6 modulates cell metastasis and growth via AKT pathway in nasopharyngeal carcinoma

“…Nasopharyngeal carcinoma (NPC) is a squamous epithelial cell carcinoma with an incidence of 15‐50 cases per 100 000 and is especially prevalent in Southeast Asia . Currently, with the application of intensity‐modulated radiotherapy, the locoregional control rate of NPC is much higher than before .…”