Induction chemotherapy with docetaxel plus cisplatin followed by concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma: 8-year follow-up

Abstract

Background: The current standard of care for locoregionally advanced nasopharyngeal carcinoma (LANPC) is concurrent chemoradiation (CRT). Unfortunately, 20% patients with LANPC still experience distant failure after CRT. Recently published prospective clinical trials and two meta-analyses have shown that, addition of induction chemotherapy (IC) before CRT, could potentially improve oncological outcomes in comparison to CRT alone. Although it remains unclear, which is the best IC regimen to be offered and for how many cycles. Unfortunately till date, there is no published data from India, regarding the outcomes of various commonly used IC regimens before CRT, in LANPC. Methods: Patients diagnosed with LANPC from January 2012 to March 2018, who received 3 cycles IC before definitive CRT, were reviewed. The inclusion criteria were: age 18 years, pathologically proven NPC, ECOG PS 2; and adequate organ functions. Major exclusion criteria were: previous therapy for NPC and evidence of metastatic disease. Patients received IC with either paclitaxel and cisplatin (TP) or paclitaxel/docetaxel, cisplatin and 5-FU (TPF) at standard doses, every 3 weeks along with primary G-CSF prophylaxis. Results: Total 38 pts received either TP (n ¼ 20) or TPF (n ¼ 18) as IC. The median age was 36 years (range, 18-62); 66% males; WHO histological type 1/2/3, 0%/18%/82%; TNM stage III/IVA/IVB, 37%/34%/29%. The ORR after 3 cycles of TP and TPF IC were 70% and 78% respectively; and the corresponding rates were 85% and 94%, after CRT. At a median follow-up of 26 months, 2-year failure-free survival and OS for TP arm were 80% and 90%; and the corresponding rates for TPF arm were 89% and 94% respectively. All Grade III-IV toxicities were numerically higher with TPF than TP: neutropenia (33% vs 15%), febrile neutropenia (17% vs 5%), mucositis (11% vs 0%) and diarrhea (11% vs 0%). Conclusions: In this retrospective analysis, there was no significant difference between taxane-based doublet and triplet IC regimens in patients with LANPC, in terms of survival outcomes; although grade III-IV toxicities were non-significantly higher with TPF. Clearly, these hypothesis generating findings should be tested in a prospective randomized setting. Legal entity responsible for the study: