Neoadjuvant chemotherapy followed by concurrent chemoradiation for locoregionally advanced nasopharyngeal carcinoma. Issue 23 (27th August 2013) - Kong, Lin
Abstract BACKGROUND The authors studied the efficacy of neoadjuvant chemotherapy, consisting of a taxane, cisplatin, and 5‐fluorouracil (5‐FU) (the TPF regimen) followed by concurrent chemoradiation, in 2 separately designed and synchronously executed phase 2 trials for stage III and IVA/IVB nasopharyngeal cancer (NPC). METHODS Patients with newly diagnosed NPC were accrued to 2 trials, 1 for patients with stage III disease and the other for patients with IVA/IVB disease. All patients received TPF (docetaxel 75 mg/m2, cisplatin 75 mg/m2, and 5‐FU 2500 mg/m2 every 3 weeks for 3 cycles) followed by cisplatin 40 mg/m2 per week concurrently with either 3‐dimentional conformal radiation therapy or intensity‐modulated radiation therapy. RESULTS From January 2007 to July 2011, 52 eligible patients with stage III NPC and 64 eligible patients with nonmetastatic stage IV NPC were accrued. With a median follow‐up of 32.9 months, the 3‐year overall survival rates were 94.8% (95% confidence interval [CI], 87.6%‐100%) and 90.2% (95% CI, 81.8%‐98.6%) for the stage III NPC group and the IVA/IVB NPC group, respectively. The 3‐year progression‐free survival, distant metastasis‐free survival, and local progression‐free survival rates were 78.2% (95% CI, 64.6%‐91.8%), 90.5% (95% CI, 79.7%‐100%), and 93.9%(87.1%‐100%), respectively, for patients with stage III NPC and 85.1% (95% CI, 75.1%‐95.1%), 88% (95% CI, 78.6%‐97.4%), and 100%, respectively, for patients with stage IVA/IVB NPC. The most common severe (grade 3/4) hematologic and nonhematologic adverse events were neutropenia (64 patients; 55.2%) and nausea/vomiting (23 patients; 19.8%). CONCLUSIONS Neoadjuvant TPF followed by concurrent chemoradiation was well tolerated and produced encouraging outcomes in patients with locally advanced NPC in this hypothesis‐generating study. The authors concluded that randomized controlled trials are warranted to definitively confirm this aggressive and potentially efficacious strategy. Cancer 2013;119:4111–4118. © 2013 American Cancer Society.