The efficacy and safety of gemcitabine-based induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation

Abstract

Objectives: To assess the efficacy and toxicity of gemcitabine-based induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in locally advanced nasopharyngeal carcinoma (LA-NPC). Methods: Both observational studies (OBS) and randomized controlled trials (RCT) were included in the meta-analysis. Systematic online searches were conducted in Web of Sciences, PubMed, Embase, meeting proceedings and ClinicalTrials.gov from the inception to May 25, 2020. The primary endpoint of interest was overall survival. Results: five OBSs and 2 RCTs including 1680 patients were incorporated in the analysis. The evidence from the RCTs showed that adding gemcitabine-based induction chemotherapy to CCRT significantly improved progression free survival (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.40–0.88; P = .010; chi square P = .25; I 2 = 24%) and overall survival (HR: 0.47; 95% CI: 0.28–0.80; P = 0.005; chi square P = .49, I 2 = 0%) and was related to a higher risk of hematological toxicities. Furthermore, based on the data of OBSs, overall survival (HR: 0.52; 95% CI: 0.31–0.88; P = .02; chi square P = .37, I 2 = 6%) was significantly improved in patients treated with gemcitabine-based induction chemotherapy compared to those treated with taxane-based induction chemotherapy. However, the progression free survival (HR: 0.67; 95% CI: 0.45–1.01; P = .06; chi square P = .74; I 2 = 0%) showed no significant difference. Conclusions: For LA-NPC patients, adding gemcitabine-based induction chemotherapy to CCRT significantly improved overall survival and progression free survival with a higher risk of hematological toxicities when compared to CCRT alone. Also, gemcitabine-based regimen could be used as an alternative induction chemotherapy regimen to taxane-based regimen in the treatment of LA-NPC.

Survival after induction chemotherapy in locoregional advanced nasopharyngeal carcinoma: An updated systematic review and meta‐analysis

“…Therefore, the treatment side effects and other related profiles are not revealed in the results. However, the current meta‐analytic results reconfirmed the significant benefits for survival of patients with locoregionally advanced NPC seen in previous meta‐analyses 26–35 . Therefore, the benefits of ICT for the survival condition of locoregionally advanced NPC might be consistent and persuasive.…”

“…[27][28][29] In addition, our meta-analysis purely focused on randomized controlled trials, which minimizes bias from retrospective studies or cohort studies as found in other meta-analyses. [32][33][34] The consistent and significant benefits of the OS, PFS, DMFS, and LRRFS seen here underscore the advantages of applying ICT for locoregionally advanced NPC patients. However, different regiments of T A B L E 1 (Continued) ICT in these studies should be considered when interpreting the meta-analysis results.…”

“…We also analyzed more survival indicators than the previous meta‐analyses 27–29 . In addition, our meta‐analysis purely focused on randomized controlled trials, which minimizes bias from retrospective studies or cohort studies as found in other meta‐analyses 32–34 . The consistent and significant benefits of the OS, PFS, DMFS, and LRRFS seen here underscore the advantages of applying ICT for locoregionally advanced NPC patients.…”

“…However, the current meta‐analytic results reconfirmed the significant benefits for survival of patients with locoregionally advanced NPC seen in previous meta‐analyses. 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 Therefore, the benefits of ICT for the survival condition of locoregionally advanced NPC might be consistent and persuasive.…”

“…The previous meta‐analysis mentioned that gemcitabine‐based ICT might be different from taxane‐based ICT from the perspective of improving the OS. 32 Another meta‐analysis suggested that the cisplatin might be related to more toxicities than other platinum compounds. The authors recommended substituting cisplatin with other platinum compounds.…”