Sequential chemoradiotherapy with gemcitabine and cisplatin for locoregionally advanced nasopharyngeal carcinoma

Abstract

We investigated a new chemoradiotherapy (CRT) regimen for locoregionally advanced nasopharyngeal carcinoma (NPC). A total of 240 patients were randomly assigned to three different CRT regimens: sequential CRT [1 cycle chemotherapy 1 Phase I radiotherapy (RT) 1 1 cycle chemotherapy 1 Phase II RT 1 2 cycles chemotherapy] with a cisplatin-gemcitabine (GC) regimen weeks) (sPF-RT) and cisplatin-based concurrent chemoradiotherapy plus adjuvant PF chemotherapy (Con-RT 1 PF). The complete response rate was higher in the sGC 1 RT group than in the other two groups (98.75% vs. 92.50%, p < 0.01). The 3-year overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) rates in the sGC-RT group were significantly higher than those observed in the Con-RT group (OS, 95.0% vs. 76.3%, p < 0.001; DFS, 89.9% vs. 67.5%, p < 0.001; DMFS, 92.5% vs. 76.0%, p 5 0.004) and in the sPF 1 RT group (OS, 95.0% vs. 73.6%, p < 0.001; DFS, 89.9% vs. 63.3%, p < 0.001; DMFS, 92.5% vs. 74.7%, p 5 0.002). There were no significant differences in 3-year OS, DFS and MFS rates between the Con-RT and the sPF-RT groups. The GC-RT group experienced more hematologic toxicity, constipation and rash; however, there were no differences in late RT toxicity between the groups. These results demonstrate that a sGC-RT regimen is effective and well tolerated in patients with locoregionally advanced NPC. Nasopharyngeal carcinoma (NPC) is endemic in SoutheastAsia, especially in the southern provinces of China. 1 Furthermore, between 63.3 and 68.1% of patients with NPC present with Stage III or IV disease in southern China.2,3 Patients with locoregionally confined advanced NPC have a worse prognosis, with frequent local relapse and distant metastases. In recent years, local tumor control for NPC has been greatly improved by developments in radiotherapy (RT) techniques; however, the incidence of distant metastases remains high, and further research is needed to address this. 4 NPC is known for its high rates of response to RT and chemotherapy. The results from the Intergroup-0099 trial, which compared concurrent chemoradiotherapy (Con-RT) plus adjuvant chemotherapy with RT alone in patients to Stages III-IVB disease, suggest that the addition of chemotherapy to RT is beneficial.5 However, a randomized trial in endemic geographic areas showed that the Intergroup-0099 regimen only improved relapse-free survival and not overall survival (OS) or distant metastasis-free survival (DMFS). Additionally, the Intergroup-0099 regimen resulted in significantly increased toxicity rates.7 Therefore, an exploration of new therapies and regimens that improve outcome and decrease treatment-related toxicity in locoregionally confined advanced NPC is needed.

Gemcitabine and cisplatin regimen facilitates prognosis of advanced nasopharyngeal carcinoma

“…Of the remaining 34 studies, full‐text assessment excluded 21 studies because of unrelated value (n = 10), insufficient data (n = 5) and duplicates (n = 6). Finally, 13 studies entered final qualitative synthesis and quantitative analysis …”

“…This study with 240 patients found the overall survival rates of 2 regimens were both 95% but reported no differences in toxicity. 24 On the contrary, Zheng reported that induction chemotherapy had no survival benefit, but the GP regimen benefited overall survival and tended to improve distant-metastasis-free survival of locoregionally advanced NPC patients. 25 The GP regimen was an independent prognostic factor for overall survival and trended to improve distant-metastasis-free survival, while the TP regimen (taxol + cisplatin) was only a significant prognostic factor for distant-metastasis-free survival.…”

“…Finally, 13 studies entered final qualitative synthesis and quantitative analysis. [14][15][16][17][18][19][20][21][22][23][24][25][26]…”

Plasma uric acid and tumor volume are highly predictive of outcome in nasopharyngeal carcinoma patients receiving intensity modulated radiotherapy

“…Our results were consistent with this, as the 7-year OS, PFS and DMFS rates for the entire cohort were 81.7%, 87.5% and 91.9%, respectively. The prognosis for NPC patients who develop metastasis is generally poor [20]. However, no specific indicator has yet been identified for this subgroup of patients.…”

Evaluation of the efficacy and safety of a neoadjuvant gemcitabine and nedaplatin regimen followed by radiotherapy or concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

“…Relatively few studies (30)(31)(32)(33) have examined the efficacy and toxicity profile of CDDP-GEM (GP regimen) or carboplatin (CBP)-GEM (GC regimen) as NACT, or during CCRT in locoregionally advanced NPC. These regimens exhibited good efficacy and tolerable toxicity profiles.…”