Assessment of Response to Different Induction Chemotherapy Regimens in Locally Advanced Nasopharyngeal Carcinoma

Overview

Journal Drug Des Devel Ther

Specialty Pharmacology

Date 2023 Mar 1

PMID 36855516

Authors

Chen-Lu Lian

Rui Zhou

Yuan Zhou

Ping Zhou

San-Gang Wu

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare the short-term treatment response and survival of the three induction chemotherapy (IC) regimens, including gemcitabine and cisplatin (GP), docetaxel and cisplatin (TP), and docetaxel, cisplatin, and fluoropyrimidines (TPF) in locally advanced nasopharyngeal carcinoma (LANPC).

Methods: We included stage III-IVA NPC patients who received ≥3 cycles of IC in this study. The chi-square test, multivariate logistic regression analysis, and Kaplan-Meier method were used for statistical analysis.

Results: A total of 227 patients were included. The overall response rate (ORR) of the primary nasopharyngeal tumors after IC with GP, TP, and TPF was 91.9%, 83.8%, and 91.7%, respectively (P=0.729), and the ORR of the cervical lymph nodes was 94.6%, 72.3%, and 85.0%, respectively (P<0.001). For the primary nasopharyngeal tumor, there was no significant difference in the ORR among the three IC regimens. For cervical lymph nodes, patients treated with GP had significantly higher ORR compared to those treated with the TP regimen (P=0.014), and comparable ORR was found between TPF and GP regimens (P=0.161). Similar progression-free survival (PFS) (P=0.501) and overall survival (OS) (P=0.504) were found among three IC regimens. There were comparable PFS (P=0.123) and OS (P=0.478) among those with complete response (CR), partial response (PR), and stable disease (SD)/progressive disease (PD) in the primary nasopharyngeal tumors. However, patients who had CR in the primary nasopharyngeal tumor (P=0.014) and the cervical lymph nodes (P=0.022) had better PFS compared to those who had PR or SD/PD.

Conclusion: GP and TPF regimens are equivalent to the TP regimen in the response to primary nasopharyngeal tumors after IC, but with better ORR in the cervical lymph nodes than the TP regimen. The response to IC may be a powerful indicator for predicting prognosis and developing individualized follow-up and treatment strategies for LANPC patients.

Citing Articles

Comparing long-term efficacy and safety of GP versus TPF sequential chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a propensity score-matched analysis.

Zhu Y, Xue F BMC Cancer. 2024; 24(1):1145.

PMID: 39271993 PMC: 11401264. DOI: 10.1186/s12885-024-12932-0.

Additional PD-1 inhibitor improves complete response to induction chemotherapy in locally advanced nasopharyngeal carcinoma.

Yu Y, Lu G, Wang R, Song Y, Wu S Front Immunol. 2024; 15:1415246.

PMID: 38911859 PMC: 11191375. DOI: 10.3389/fimmu.2024.1415246.

Toripalimab plus cetuximab combined with radiotherapy in a locally advanced platinum-based chemotherapy-insensitive nasopharyngeal carcinoma patient: a case report.

Piao Y, Yang Y, Wu S, Han L Front Oncol. 2024; 14:1383250.

PMID: 38800412 PMC: 11127563. DOI: 10.3389/fonc.2024.1383250.

References

Zang J, Xu M, Li C, Zhao L, Luo S, Wang J . Gemcitabine and cisplatin versus docetaxel and cisplatin as induction chemotherapy followed by concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma from non-endemic area of China. J Cancer Res Clin Oncol. 2020; 146(9):2369-2378. DOI: 10.1007/s00432-020-03229-3. View

Zhang Y, Chen L, Hu G, Zhang N, Zhu X, Yang K . Gemcitabine and Cisplatin Induction Chemotherapy in Nasopharyngeal Carcinoma. N Engl J Med. 2019; 381(12):1124-1135. DOI: 10.1056/NEJMoa1905287. View

Jin Y, Shi Y, Cai X, Xia X, Cai Y, Cao Y . Comparison of five cisplatin-based regimens frequently used as the first-line protocols in metastatic nasopharyngeal carcinoma. J Cancer Res Clin Oncol. 2012; 138(10):1717-25. DOI: 10.1007/s00432-012-1219-x. View

Zhu J, Duan B, Shi H, Li Y, Ai P, Tian J . Comparison of GP and TPF induction chemotherapy for locally advanced nasopharyngeal carcinoma. Oral Oncol. 2019; 97:37-43. DOI: 10.1016/j.oraloncology.2019.08.001. View

Lee H, Hwang Y, Han J, Choi J, Kang S, Jeong S . High expression of excision repair cross-complementation group 1 protein predicts poor outcome in patients with nasopharyngeal cancer. Oral Oncol. 2010; 46(3):209-13. DOI: 10.1016/j.oraloncology.2009.12.007. View

Tang L, Chen Y, Chen C, Chen M, Chen N, Chen X . The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma. Cancer Commun (Lond). 2021; 41(11):1195-1227. PMC: 8626602. DOI: 10.1002/cac2.12218. View

Jiang Y, Chen K, Liang Z, Yang J, Wei S, Qu S . A nomogram based on tumor response to induction chemotherapy may predict survival in locoregionally advanced nasopharyngeal carcinoma. Head Neck. 2022; 44(6):1301-1312. DOI: 10.1002/hed.27020. View

Hui E, Ma B, Leung S, King A, Mo F, Kam M . Randomized phase II trial of concurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma. J Clin Oncol. 2008; 27(2):242-9. DOI: 10.1200/JCO.2008.18.1545. View

Sato H, Hatori M, Ando Y, Kurihara Y, Takayama S, Shirota T . S-1 mediates the inhibition of lymph node metastasis in oral cancer cells. Oncol Rep. 2009; 22(4):719-24. DOI: 10.3892/or_00000492. View

10.

Peng H, Chen L, Li W, Guo R, Mao Y, Zhang Y . 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. Cancer. 2016; 123(9):1643-1652. DOI: 10.1002/cncr.30520. View

11.

Pan J, Ng W, Zong J, Lee S, Choi H, Chan L . Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. Cancer. 2016; 122(21):3307-3315. PMC: 5524130. DOI: 10.1002/cncr.30198. View

12.

Caudell J, Gillison M, Maghami E, Spencer S, Pfister D, Adkins D . NCCN Guidelines® Insights: Head and Neck Cancers, Version 1.2022. J Natl Compr Canc Netw. 2022; 20(3):224-234. DOI: 10.6004/jnccn.2022.0016. View

13.

Wang W, Peng S, Wu H, Luo Y, Yuan F, Lin Z . Association of tumor downstaging after neoadjuvant chemotherapy with survival in patients with locally advanced nasopharyngeal carcinoma: a retrospective cohort study. J Cancer Res Clin Oncol. 2021; 147(10):2913-2922. DOI: 10.1007/s00432-021-03690-8. View

14.

Tsuruo T, Naganuma K, Iida H, Tsukagoshi S . Lymph node metastasis and effects of 1-beta-D-arabinofuranosylcytosine, 5-fluorouracil, and their lipophilic derivatives in an experimental model system using P388 leukemia. Cancer Res. 1980; 40(12):4758-63. View

15.

Li W, Chen N, Zhang N, Hu G, Xie F, Sun Y . Concurrent chemoradiotherapy with/without induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma: Long-term results of phase 3 randomized controlled trial. Int J Cancer. 2019; 145(1):295-305. DOI: 10.1002/ijc.32099. View

16.

Lee A, Tung S, Ngan R, Chappell R, Chua D, Lu T . Factors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: combined analyses of NPC-9901 and NPC-9902 Trials. Eur J Cancer. 2010; 47(5):656-66. DOI: 10.1016/j.ejca.2010.10.026. View

17.

Xu Y, Wu Z, Ye W, Xiao Y, Zheng W, Chen Q . Prognostic value of serum uric acid and tumor response to induction chemotherapy in locally advanced nasopharyngeal carcinoma. BMC Cancer. 2021; 21(1):519. PMC: 8106149. DOI: 10.1186/s12885-021-08285-7. View

18.

Chen Y, Chan A, Le Q, Blanchard P, Sun Y, Ma J . Nasopharyngeal carcinoma. Lancet. 2019; 394(10192):64-80. DOI: 10.1016/S0140-6736(19)30956-0. View

19.

Liu L, Tang L, Chen Q, Zhang L, Guo S, Guo L . The Prognostic Value of Plasma Epstein-Barr Viral DNA and Tumor Response to Neoadjuvant Chemotherapy in Advanced-Stage Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys. 2015; 93(4):862-9. DOI: 10.1016/j.ijrobp.2015.08.003. View

20.

Zhong Y, Dai J, Wang X, Xie C, Chen G, Zeng L . Phase II trial of neoadjuvant docetaxel and cisplatin followed by intensity-modulated radiotherapy with concurrent cisplatin in locally advanced nasopharyngeal carcinoma. Cancer Chemother Pharmacol. 2013; 71(6):1577-83. DOI: 10.1007/s00280-013-2157-2. View