Cetuximab or nimotuzumab plus intensity-modulated radiotherapy versus cisplatin plus intensity-modulated radiotherapy for stage II-IVb nasopharyngeal carcinoma

Abstract

To compare intensity-modulated radiotherapy (IMRT) with cisplatin (CDDP) versus cetuximab (CTX) and nimotuzumab (NTZ) for Stage II-IVb Nasopharyngeal Carcinoma (NPC). A total of 1,837 patients with stage II-IV NPC who received IMRT plus CTX or NTZ, or CDDP between January 2009 and December 2013 were included in the current analysis. Using propensity scores to adjust for potential prognostic factors, a well-balanced cohort of 715 patients was created by matching each patient who underwent IMRT plus concomitant NTZ/CTX with four patients who underwent IMRT plus concomitant CDDP (1:4). Efficacy and safety were compared between the CTX/NTZ and CDDP groups of this well-balanced cohort. Furthermore, we conducted multivariate analysis and subgroup analysis based on all the 1,837 eligible cases. There was no significant difference between CTX/NTZ group and CDDP group in terms of DFS (3-year, 86.7% vs. 86.2%, p > 0.05), LRRFS (96.2% vs. 96.3%, p > 0.05), DMFS (91.1% vs. 92.3%, p > 0.05) and OS (91.7% vs. 91.9%, p > 0.05). Subgroup analysis demonstrated a significant interaction effect between patients with IMRT plus CTX/NTZ and N3 node stage on LRRFS with the highest risk of loco-regional relapse (HR 8.85, p = 0.001). Significantly increased hematologic toxicities, gastrointestinal reactions were observed in the CDDP group (p < 0.05). Patients of 3.4-4.7% experienced severe hematologic toxicities during the treatment with concomitant CTX and NTZ. Increased rate of CTX related-skin reaction and mucositis was observed in the CTX group. CTX/NTZ used concurrently with IMRT may be comparable to those of the standard CDDP-IMRT combination for maximizing survival for patients with stage II-IVb NPC.

Anti‐epidermal growth factor receptor therapy concurrently with induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma

“…Overall, grade 3‐4 toxic events were more common in the IC + CTX/NTZ group than in the IC alone group, and significant differences mainly occurred in anti‐EGFR therapy‐related toxicities like skin reactions and mucositis. However, the incidence of severe skin and mucositis in our study was significantly less compared with the results in previous studies . Undoubtedly, CTX/NTZ aggravated radiation‐induced skin and oral mucositis.…”

“…However, the incidence of severe skin and mucositis in our study was significantly less compared with the results in previous studies. 10,[12][13][14] Undoubtedly, CTX/NTZ aggravated radiation-induced skin and oral mucositis. Another reason may be that the total dose used in the induction phase is less than that used in concurrent phase.…”

“…6,7 EGFR is also highly expressed in NPC 8 and numerous studies have evaluated the efficacy of anti-EGFR targeted therapy. [9][10][11][12][13][14][15] Cetuximab (CTX) or nimotuzumab (NTZ) (anti-EGFR monoclonal antibodies) concurrent with RT could achieve comparable outcomes compared with standard cisplatin-RT. 12,14 When combined with CCRT, different results were produced.…”

“…[9][10][11][12][13][14][15] Cetuximab (CTX) or nimotuzumab (NTZ) (anti-EGFR monoclonal antibodies) concurrent with RT could achieve comparable outcomes compared with standard cisplatin-RT. 12,14 When combined with CCRT, different results were produced. You et al 13 and Xia et al 11 revealed that CTX/NTZ additional to CCRT was more effective than CCRT alone, while Li et al 10 did not identify any difference.…”

Discrepant expression and prognostic role of epidermal growth factor receptor and icotinib radiosensitization for nasopharyngeal carcinoma

“…For the former, Huang et al demonstrated that concurrent administration of nimotuzumab and celecoxib cooperatively enhanced the cytotoxicity and radiosensitivity of NPC cells (CNE-2) in vitro [10]. Clinical studies have shown that cetuximab or nimotuzumab, combined with radiotherapy can enhance the efficacy of radiotherapy with a better safety profile [11][12][13].…”