Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy with or without nimotuzumab in the treatment of locally advanced nasopharyngeal carcinoma: a retrospective study

Abstract

Purpose We aimed to investigate the efficacy and side effects of concurrent chemoradiotherapy, with or without nimotuzumab, for the treatment of locally advanced nasopharyngeal carcinoma after neoadjuvant chemotherapy. Methods This study retrospectively enrolled 109 patients with NPC from our hospital from July 2019 to May 2021.All patients were treated with docetaxel, cisplatin, and fluorouracil(TPF) neoadjuvant chemotherapy for 2 cycles, and concurrent chemoradiotherapy was performed 2 weeks after chemotherapy. According to whether nimotuzumab was added in concurrent chemoradiotherapy, they were divided into the nimotuzumab group and the control group, with 52 cases in the nimotuzumab group and 57 cases in the control group.The efficacy and adverse reactions of the two groups were retrospectively analyzed. Results The objective remission and complete remission rates in the nimotuzumab and control groups were 100% vs 98.2% (p = 1.000), and 92.3% vs 78.9% (p = 0.049), respectively. The 3-year distant metastasis-free survival of the nimotuzumab and control groups was 91.6% and 77.3% (p = 0.047), respectively.The 3-year progression-free survival, locoregional relapse-free survival, and overall survival of the nimotuzumab and control groups were 87.6% vs 75.5% (p = 0.110), 90.5% vs 86.9% (p = 0.566), and 94.5% vs 87.1% (p = 0.295), respectively. In the nimotuzumab group, subgroup analysis showed that patients aged < 60 years (hazard ratio [HR] = 0.350, 95% confidence interval [CI]: 0.131–0.934, p = 0.036) and those with a neutrophil-to-lymphocyte ratio (neutrophil/lymphocyte ratio) ≤ 4 (HR = 0.365, 95% CI: 0.144–0.923, p = 0.033) achieved a better result. Additionally, multivariate analysis demonstrated that neutrophil/lymphocyte ratio was an independent risk factor for disease progression (HR = 7.485, p = 0.012) and distant metastasis (HR = 17.540, p = 0.009).No grade 4 adverse reactions were observed in either group. Grade 3 oral mucosal reactions, as well as pharyngeal and esophageal reactions were slightly higher in the nimotuzumab group than in the control group, but the difference was not statistically significant. No significant differences were observed in the incidence of adverse reactions such as leukopenia, HB reduction, thrombocytopenia between the two groups (P > 0.05). Conclusion The concurrent chemoradiotherapy plus nimotuzumab after neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma achieved a higher complete remission rate and significantly improved distant metastasis-free survival compared with concurrent chemoradiotherapy alone. Additionally, an increasing trend was observed in progression-free survival, and the incidence of side effects was similar in both groups.

Addition of nimotuzumab to concurrent chemoradiotherapy after induction chemotherapy improves outcomes of patients with locally advanced nasopharyngeal carcinoma

“…In China, nimotuzumab treatment can be reimbursed by medical insurance for LANPC patients with EGFR-positive disease. In this study, a total of 267 patients received nimotuzumab treatment, and the proportion of our patients receiving nimotuzumab was higher than in other studies (65% vs. 6.4%–38.8%) ( Zhai et al, 2015 ; You et al, 2017 ; Zhang et al, 2018a ; Zhang et al, 2018b ; Yao et al, 2018 ; Zhi-Qiang et al, 2019 ; Fei et al, 2020 ; Cai et al, 2023 ; Jiang et al, 2023 ; Lu et al, 2023 ; Yang et al, 2023 ). Our study found that the addition of nimotuzumab to CCRT significantly improved DMFS, DFS, and OS in patients after two to three cycles of IC.…”

“…This suggests that nimotuzumab can be safely combined with CCRT for the treatment of LANPC. Several studies have also found similar results, supporting the safety of combining nimotuzumab with CCRT in LANPC (Yao et al, 2018;Zhi-Qiang et al, 2019;Fei et al, 2020;Cai et al, 2023;Yang et al, 2023). The results from the prospective study also found a similar rate of oral mucositis between those treated with CCRT+nimotuzumab and CCRT alone (p = 0.207) (Sun et al, 2022).…”

“…Several retrospective studies have explored the efficacy of the addition of nimotuzumab during CCRT after IC, but inconsistent results have been found. Yang et al (2023) found that the addition of nimotuzumab during CCRT after IC ( n = 52) could improve DMFS compared to those treated with CCRT alone ( n = 57) (91.6% vs. 77.3% p = 0.047), but there was no significant effect on LRFS ( p = 0.566), DFS ( p = 0.110), and OS ( p = 0.295). In addition, the results of multivariate analysis did not show that using nimotuzumab could improve DMFS of patients.…”

“…The addition of nimotuzumab to the treatment regimen may have the potential to increase tumor response, reduce distant metastasis, and improve outcomes in LANPC patients ( Chen et al, 2020 ; Liang et al, 2021 ). However, the existing literature showed mixed results regarding the use of nimotuzumab in LANPC ( Fei et al, 2020 ; Jiang et al, 2023 ; Yang et al, 2023 ). The main reasons for the differences in the above results may include variations in treatment strategies and small sample sizes of the enrolled patients.…”