Which neoadjuvant chemotherapy regimen should be recommended for patients with advanced nasopharyngeal carcinoma?

Abstract

Background:The clinical application has widespread disagreement on the different regimens of neoadjuvant chemotherapy (NCT) in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). We conducted a network meta-analysis (NMA) to evaluate the efficacy of the different NCT regimens in the treatment of NPC.Methods:A systematic literature search was performed using PubMed, Embase, and Cochran Library. Totally, 31 randomized controlled trials (RCTs) (n = 4062) met study selection criteria and were incorporated in this NMA study.Results:Our study showed that certain NCT regimens improved the prognosis of patients, and found out the relative best solution for each endpoint, such as paclitaxel, carboplatin, and gemcitabine for 1-year overall survival (OS) rate, cisplatin, calcium folinate, and 5-fluorouracil for 2-year OS rate, vinorelbine and cisplatin (NP) for 3-year OS rate, cyclophosphamide, cisplatin, and 5-fluorouracil for 5-year OS rate, NP for complete remission rate, cisplatin and gemcitabine for overall remission rate of the primary tumor. In addition, for certain grade 3 and above toxicity, the results of the NMA reflected certain NCT regimens can reduce toxicity of chemoradiotherapy (CRT) to a minimum, such as NP for anemia, mucositis, and thrombocytopenia, paclitaxel, epirubicin, and cisplatin for neutropenia and skin toxicity.Conclusion:Our NMA showed that certain cisplatin-based NCT regimens improved the prognosis of patients with NPC and reduced the toxicity of CRT. However, in view of survival rate and response rate, the best NCT regimen is not entirely consistent. Therefore, which NCT regimen will benefit most patients will need further explored.

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

“…Several IC regimens, including TP (docetaxel, cisplatin), FP (cisplatin, fluorouracil), and TFP (docetaxel, cisplatin, fluorouracil), are known to improve the survival of patients with NPC. [ 18 , 19 ] A multicenter randomized phase III trial showed that the efficacy of gemcitabine combined with cisplatin (GP) as IC for recurrent or metastatic NPC was similar to that of TFP, and the incidence of 3 or 4 grade adverse events (AEs) was significantly reduced in GP group. [ 19 ] Moreover, gemcitabine has showed high therapeutic efficacy in various tumor types.…”

Concurrent chemoradiotherapy with additional chemotherapy for nasopharyngeal carcinoma: A pooled analysis of propensity score‐matching studies

“…In contrast, the other two meta‐analyses revealed the advantages of IC + CCRT over those of CCRT for LANPC, including improvements in OS, progression‐free survival, and DMFS 34,35 . Discrepancies in the survival benefits of IC + CCRT might be related to the use of different chemotherapy drugs 36 . Two meta‐analyses 34,35 conducted after 2015 used new IC regimens (e.g., paclitaxel, carboplatin, and gemcitabine; docetaxel, cisplatin, and 5‐fluorouracil; and cisplatin and gemcitabine), revealing positive results in terms of OS and DMFS that were different from those of the three meta‐analyses 31‐33 published before 2015.…”

Association of tumor downstaging after neoadjuvant chemotherapy with survival in patients with locally advanced nasopharyngeal carcinoma: a retrospective cohort study

“…NACT of sufficient intensity can remove tiny distant metastases and reduce metastasis's likelihood (Kong et al 2017;Wang et al 2016). Therefore, the appropriate intensity of NACT can improve the prognosis of radical radiotherapy for NPC, but there is still no consensus regarding the intensity and therapeutic regimen of NACT in LANPC (Yuan et al 2018).…”