Tumor response to neoadjuvant chemotherapy predicts long‐term survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma: A secondary analysis of a randomized phase 3 clinical trial

Peng, Hao; Chen, Lei; Li, Wen‐Fei; Guo, Rui; Mao, Yan‐Ping; Zhang, Yuan; Guo, Ying; Sun, Ying; Ma, Jingfei

doi:10.1002/cncr.30520

Cited by 57 publications

(45 citation statements)

References 42 publications

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“…In contrast, all the patients included in the present study received IC plus CCRT, and the radiotherapy modality was consistently IMRT. The rationale for the decreased CCD was based on the reduced tumor volume after IC, impaired medication adherence after intensive IC, increased survival outcomes by adding IC before CCRT and significant advances in RT delivery techniques (such as IMRT) . The cCR plus pCR rates have been reported to reach 90% after IC; therefore, the subsequent administration of less intensive chemotherapy during RT is feasible.…”

Section: Discussionmentioning

confidence: 99%

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Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients receiving additional induction chemotherapy

Zhou

et al. 2018

Cancer Science

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To clarify the optimal cumulative cisplatin dose (CCD) in locoregionally‐advanced nasopharyngel carcinoma (NPC) patients receiving induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT). Using the NPC‐specific database from the established big‐data intelligence platform at Sun Yat‐Sen University Cancer Center, 583 non‐disseminated, locoregionally‐advanced NPC patients receiving IC plus CCRT were enrolled. Propensity score matching (PSM) analysis was conducted to control for confounding factors. The median CCD was 160 mg/m2 after IC (range, 40‐300 mg/m2); only 74 patients (12.7%) achieved CCD >200 mg/m2. Patients receiving >200 mg/m2 CCD did not show significantly improved 5‐year overall survival (OS) (HR = 1.19; 95% confidence intervals [CI] 0.69‐2.06, P = .53) and progression‐free survival (PFS) (HR = 1.03; 95% CI: 0.63‐1.68, P = .92) compared with patients receiving <200 mg/m2 CCD. Further investigations of the potential of median CCD (160 mg/m2) to yield survival benefits revealed that there were no significant differences in survival endpoints between patients receiving CCD >160 mg/m2 and CCD < 160 mg/m2 in both the original and PSM cohorts. In addition, subgroup analysis indicated a favorable PFS, but not OS, with higher cisplatin administration in patients with pretreatment Epstein–Barr virus deoxyribonucleic acid (EBV DNA) <1000 copies/mL (HR = 0.26, 95% CI: 0.07‐0.93, P = .03) and receiving <3 IC cycles (HR = 0.59, 95% CI 0.33‐1.07, P = .08). Our analysis of real world data provided references for the optimal CCD in locoregionally‐advanced NPC receiving additional IC. The causal relationship between 200 mg/m2 CCD and improved survival was not defined; 160 mg/m2 CCD might be enough. However, for patients with EBV DNA <1000 copy/mL and receiving <3 IC cycles, a higher dose might be necessary.

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Section: Discussionmentioning

confidence: 99%

“…First, IC greatly reduced tumor volume burden. Clinical complete response (cCR) and partial response (cPR) were observed in 11.3% and 79.6% of patients, respectively . Second, patients may be less able to tolerate the subsequent highly intensive CCRT after 2‐4 cycles of IC.…”

Section: Introductionmentioning

confidence: 99%

Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients receiving additional induction chemotherapy

Zhou

et al. 2018

Cancer Science

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“…The prognostic value of tumor response to IC for LFFS was demonstrated in the multivariate analysis. A secondary analysis of a randomized phase 3 clinical trial8 also revealed that the 3-year failure-free survival rates in the CR (88.5% vs 61.9%; P =0.017) and PR (81.2% vs 61.9%; P =0.01) groups were obviously higher than that of the SD group, and concluded that the tumor response to IC with a TPF regimen may be helpful in developing individualized treatment strategies for patients with locoregionally advanced NPC. In this context, we recommend our method of reduced GTV delineation for patients with local OR after IC, considering the high LFFS rate of 94.1%.…”

Section: Discussionmentioning

confidence: 99%

Induction chemotherapy followed by intensity-modulated radiotherapy with reduced gross tumor volume delineation for stage T3-4 nasopharyngeal carcinoma

Xue¹,

Hu²,

He³

2017

OTT

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PurposeA common problem in stage T3–4 nasopharyngeal carcinoma (NPC) is the narrow gap between the primary tumor and neurological structures, which makes dose optimization difficult. Considering that significant tumor shrinkage may occur during induction chemotherapy (IC), this study explored the efficacy of intensity-modulated radiotherapy (IMRT) using reduced gross tumor volume (GTV) in the treatment of T3–4 NPC.Patients and methodsBetween January 2009 and April 2014, 103 patients with non-metastatic stage T3–4 NPC were prospectively recruited. They were assigned to accept IC, followed by reduced-volume IMRT and adjuvant chemotherapy. GTV was based on the post-IC volume of intracavity tumors and lymph nodes, and the pre-IC volume of the remaining involved structures.ResultsFor all treated patients, the 3-year local failure-free survival (LFFS) was 91.9%. After IC, 91 (88.3%) patients achieved local objective response (OR), and their 3-year LFFS rates were significantly better than in patients who failed to achieve local OR (94.1% vs 75.0%, P=0.023). A multivariate analysis demonstrated the prognostic value of tumor response to IC for LFFS. Dosimetric analysis showed good homogeneity, and the dose constraints were stringent. Asymptomatic temporal lobe necrosis in the ipsilateral side of tumor occurred in one patient.ConclusionIMRT using a reduced GTV delineation delivered satisfactory doses to the target volumes and avoided overdosing of critical neurological structures. Results showed satisfactory survival outcomes with few treatment-related toxicities. Tumor response to IC could facilitate selection of patients with stage T3–4 NPC eligible for treatment with this method.

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“…Neoadjuvant chemotherapy (NAC) followed by intensity‐modulated radiotherapy (IMRT) has currently been widely accepted as an attractive approach in lieu of establishing concurrent chemoradiation therapy (CCRT) in nasopharyngeal carcinoma (NPC) . CCRT is frequently accompanied by acute and late dose‐limiting toxicities, hindering its common use .…”

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Integrating dynamic contrast‐enhanced magnetic resonance imaging and diffusion kurtosis imaging for neoadjuvant chemotherapy assessment of nasopharyngeal carcinoma

Zheng

Lai

Chen

et al. 2018

Magnetic Resonance Imaging

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Tumor response to neoadjuvant chemotherapy predicts long‐term survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma: A secondary analysis of a randomized phase 3 clinical trial

Abstract: Tumor response to TPF may be a properly powerful prognosis predictor and help to develop individualized treatment strategies for patients with locoregionally advanced NPC. Cancer 2017;123:1643-1652. © 2017 American Cancer Society.

Cited by 57 publications

References 42 publications

Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients receiving additional induction chemotherapy

Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients receiving additional induction chemotherapy

Induction chemotherapy followed by intensity-modulated radiotherapy with reduced gross tumor volume delineation for stage T3-4 nasopharyngeal carcinoma

Integrating dynamic contrast‐enhanced magnetic resonance imaging and diffusion kurtosis imaging for neoadjuvant chemotherapy assessment of nasopharyngeal carcinoma

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