Use of taxane-containing induction chemotherapy in combination with concurrent chemoradiotherapy in Chinese patients with locally advanced nasopharyngeal carcinoma: a meta-analysis

Abstract

PurposeTaxane-containing induction chemotherapy (IC) regimens in combination with concurrent chemoradiotherapy (CCRT) have been compared with non-taxane-containing IC combined with CCRT in randomized controlled trials (RCTs) in Chinese patients with advanced nasopharyngeal carcinoma (NPC). This meta-analysis aimed to systematically evaluate their clinical efficacy and safety profiling in this ethnic population.MethodsThe electronic databases, PubMed, Embase, MEDLINE, and Chinese Biomedical Database, were searched for eligible studies. The outcomes included overall response rate (ORR), 1-year survival rate, and different types of adverse events. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the strength of the associations.ResultsA total of 12 RCTs (representing 835 patients) were identified. The pooled analysis showed that taxane-containing regimens had a significant improvement in ORR for nasopharyngeal lesion (OR =4.57, 95% CI =1.14–18.30, P=0.032, z=2.15) but not in cervical lymph nodes (OR =1.23, 95% CI =0.65–2.36, P=0.532, z=0.64) and in 1-year survival rates (OR =1.19, 95% CI =0.10–14.82, P=0.893, z=0.13) compared with non-taxane-containing regimens. Regarding the adverse events and toxicities, grade 3–4 leukopenia and neutropenia were significantly different between the two groups (P<0.001) in favor of the non-taxane-containing regimens, but grade 3–4 vomiting was significantly different between the two groups (P<0.005) in favor of the taxane-containing regimens.ConclusionWhen combined with CCRT, taxane-containing IC regimens may be more efficient for short-term local control in Chinese patients with locally advanced NPC than the non-taxane-containing IC regimens. Moreover, the major toxic effects, which were bone marrow suppression, could be tolerated by majority of patients. More long-term follow-up and high-quality trials of NPC are needed to validate our findings.

Assessment of Concurrent Chemoradiotherapy plus Induction Chemotherapy in Advanced Nasopharyngeal Carcinoma: Cisplatin, Fluorouracil, and Docetaxel versus Gemcitabine and Cisplatin

“…Furthermore, a randomised phase III trial (NCT00003888) published in The New England Journal of Medicine, reported that induction chemotherapy with cisplatin, 5-FU plus docetaxel (TPF), was comparable to the regimen of cisplatin and 5-FU (PF), but significantly improved PFS and OS in patients with locoregionally advanced head and neck cancers 20 . Taxane-containing induction chemotherapy improved the treatment outcomes equally in patients with locally advanced NPC compared with the non-taxane chemotherapy 6 , 21 .…”

Radiation-induced sarcomas of the head and neck in post-radiation nasopharyngeal carcinoma

“…Compared with post-radiation squamous cell carcinoma (SCC) [1], radiation-induced sarcomas (RIS) of the head and neck following RT for NPC are even less common, with a crude incidence in adults of less than 0.5 % in various situations [1–5]. With improved patient survival [6–8], RIS is likely to be encountered more frequently. It is now generally believed that complete surgical resection of RIS provides the only chance of a cure [3, 4].…”

Administration of nimotuzumab combined with cisplatin plus 5-fluorouracil as induction therapy improves treatment response and tolerance in patients with locally advanced nasopharyngeal carcinoma receiving concurrent radiochemotherapy: a multicenter randomized controlled study

“…The efficacy of induction therapy may therefore affect patient survival and prognosis [25]. It was reported that induction therapy with taxanes significantly increases ORR (OR = 4.57, 95%CI 1.14–18.30, P = 0.032, z = 2.15) [26] compared with the non-taxane regimen. However, in this study, induction therapy with NPF had higher RR in lymph node lesions (81.0% vs 60%) compared with DPF.…”

“…Adverse reactions caused by induction chemotherapy, especially increased systemic toxicity, hamper the application of induction chemotherapy and follow-up concurrent radiochemotherapy to a certain extent. It was reported that the incidence of grade 3–4 neutropenia in taxane-based induction therapy is significantly higher than that of non-taxane containing regimens (39.1% vs 16.1%, OR = 3.62, 95%CI 2.42–5.40, P < 0.001, z = 6.29) [26]. The incidence rates of neutropenia and stomatitis were 42 and 41%, respectively, after addition of the DPF regimen based on CCRT, which affected compliance with IC and subsequent CCRT.…”