A phase II study of induction carboplatin and gemcitabine followed by chemoradiotherapy for the treatment of locally advanced nasopharyngeal carcinoma

Lim, Annette; Corry, June; Collins, Marnie; Peters, Lester J.; Hicks, Rodney J.; D’Costa, Ieta; Coleman, Andrew; Chua, Margaret; Solomon, Benjamin; Rischin, Danny

doi:10.1016/j.oraloncology.2012.12.012

Cited by 29 publications

(25 citation statements)

References 19 publications

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“…Additionally, neoadjuvant GEM + NDP achieved a similar nodal RR (90.3%) to CDDP + GEM (92%) (32), and markedly higher nodal RR than CBP + GEM (59.2%) (30). The primary reason for the large differences between the present results and those of Lim et al (30) is that 5/27 patients in the latter study exhibited SD, resulting in a low RR. In addition, each of these studies employed different chemotherapy regimens and drug-delivery methods, and the evaluation methods also varied.…”

Section: C B a Discussioncontrasting

confidence: 45%

“…In addition, each of these studies employed different chemotherapy regimens and drug-delivery methods, and the evaluation methods also varied. For example, the current study defined small nodes with no blood flow signals or unenhanced nodes on MRI as CR, while Lim et al (30) may have classified these features as PR, using the modified RECIST 1.0 criteria. Additionally, Yau et al (32) reported a higher CR rate for the primary site compared with the present study (49% vs. 13.4%).…”

Section: C B a Discussionmentioning

confidence: 94%

“…Compared with the CBP + GEM or CDDP + GEM regimens, neoadjuvant GEM + NDP exhibited a similar efficacy in the treatment of locoregionally advanced NPC. As shown in Table VI, neoadjuvant GEM + NDP resulted in a higher primary site response rate (RR; 95.1%) compared with CBP + GEM (77.8%) (30), and similar a RR to CDDP + GEM (95%) (25). Additionally, neoadjuvant GEM + NDP achieved a similar nodal RR (90.3%) to CDDP + GEM (92%) (32), and markedly higher nodal RR than CBP + GEM (59.2%) (30).…”

Section: C B a Discussionmentioning

confidence: 96%

“…As shown in Table VI, neoadjuvant GEM + NDP resulted in a higher primary site response rate (RR; 95.1%) compared with CBP + GEM (77.8%) (30), and similar a RR to CDDP + GEM (95%) (25). Additionally, neoadjuvant GEM + NDP achieved a similar nodal RR (90.3%) to CDDP + GEM (92%) (32), and markedly higher nodal RR than CBP + GEM (59.2%) (30). The primary reason for the large differences between the present results and those of Lim et al (30) is that 5/27 patients in the latter study exhibited SD, resulting in a low RR.…”

Section: C B a Discussionmentioning

confidence: 96%

“…Relatively few studies (30)(31)(32)(33) have examined the efficacy and toxicity profile of CDDP-GEM (GP regimen) or carboplatin (CBP)-GEM (GC regimen) as NACT, or during CCRT in locoregionally advanced NPC. These regimens exhibited good efficacy and tolerable toxicity profiles.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the efficacy and safety of a neoadjuvant gemcitabine and nedaplatin regimen followed by radiotherapy or concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

2015

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Abstract. The aim of the present study was to evaluate the efficacy and safety of a neoadjuvant gemcitabine and nedaplatin chemotherapy regimen, followed by concurrent chemoradiotherapy or radiotherapy alone, in locoregionally advanced nasopharyngeal carcinoma (NPC). Eighty-six patients with stage III, IVA or IVB NPC, who received neoadjuvant chemotherapy [gemcitabine, 1,000 mg/m 2 on day 1 (d1) and d5; nedaplatin, 25 mg/m 2 on d 1-3] every 3 weeks for at least two cycles, followed by intensity-modulated radiotherapy every 3 weeks, with or without concurrent nedaplatin (25 mg/m 2 , d1-3) between September 2010 and December 2013, were retrospectively analyzed. By comparing pretreatment and post-treatment MRI images, it was shown that seven patients achieved a complete response (8.5%), while 66 achieved a partial response (80.5%), following completion of neoadjuvant chemotherapy (combined response rate, 89.0%). Grade 3-4 toxicities following neoadjuvant chemotherapy included neutropenia (29.1%), leukopenia (11.6%), liver dysfunction (9.3%), thrombocytopenia (9.3%) and nausea/vomiting (8.1%). The median follow-up was 18 months (range, 5-44 months). The 2-year relapse-free survival, distant metastasis-free survival, progression-free survival and overall survival rates were 96.6, 85.4, 83.3 and 96.1%, respectively. Compared with alternative neoadjuvant chemotherapy regimens in combination with radiotherapy or concurrent chemoradiotherapy, the present gemcitabine and nedaplatin did not provide additional survival benefit and led to a higher frequency of liver dysfunction. Therefore, neoadjuvant gemcitabine and nedaplatin should be used with caution in locoregionally advanced NPC.

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Section: C B a Discussioncontrasting

confidence: 45%

Section: C B a Discussionmentioning

confidence: 94%

Section: C B a Discussionmentioning

confidence: 96%

Section: C B a Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Evaluation of the efficacy and safety of a neoadjuvant gemcitabine and nedaplatin regimen followed by radiotherapy or concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

2015

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Induction Chemotherapy Followed by Radiotherapy vs Chemoradiotherapy in Nasopharyngeal Carcinoma

Dai,

Zhang,

et al. 2024

JAMA Oncol

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ImportanceInduction chemotherapy plus concurrent chemoradiotherapy is recommended for locoregionally advanced nasopharyngeal carcinoma but is associated with higher rates of acute toxic effects and low compliance. Evidence on de-escalating treatment intensity after induction chemotherapy is limited.ObjectiveTo assess if radiotherapy was noninferior to chemoradiotherapy after induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma.Design, Setting, and ParticipantsFrom April 2015 to March 2018, a multicenter, open-label, randomized, noninferiority, phase 3 trial was conducted at 5 Chinese hospitals. A total of 383 patients aged 18 to 70 years with an untreated histologically confirmed nonkeratinizing tumor, Karnofsky performance status score not worse than 70, proper organ function, and stage III to IVB nasopharyngeal cancer were enrolled. Data were analyzed from April 2023 to June 2023.InterventionsPatients were assigned randomly. Both groups received 3 cycles of induction chemotherapy consisting of intravenous administration (on day 1) of cisplatin at 60 mg/m2 and docetaxel at 60 mg/m2 and continuous intravenous infusion (from day 1 to day 5) of daily fluorouracil (600 mg/m2), repeated every 21 days. Subsequently, the patients received radiotherapy alone (induction chemotherapy in combination with radiotherapy [IC-RT] group) or concomitant cisplatin (30 mg/m2/week) with radiotherapy for 6 to 7 weeks (induction chemotherapy combined with chemoradiotherapy [IC-CCRT] group).Main Outcomes and MeasuresThe primary end point was 3-year progression-free survival (time from the initiation of therapy until the first indication of disease progression or death), with a noninferiority margin of 10%. The secondary end points included overall survival, locoregional failure-free survival, distant metastasis-free survival, response rate, and toxic effects.ResultsA total of 383 patients (median [range] age, 48 [19-70] years; 100 women [26%]). Median follow-up time was 76 months (IQR, 70-89 months). The 3-year progression-free survival was 76.2% and 76.8% in the IC-RT (n = 193) and IC-CCRT groups (n = 190), respectively, in the intention-to-treat population, showing a difference of 0.6% (95% CI, –7.9% to 9.1%; P = .01 for noninferiority). Identical outcomes were reported in the per-protocol population. The incidence of grade 3 to 4 short-term toxic effects in the IC-RT group was less than the IC-CCRT group. No differences were observed in late toxic effects.Conclusions and RelevanceThe results of this randomized clinical trial suggest that after induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma, radiotherapy alone was noninferior to chemoradiotherapy in terms of 3-year progression-free survival.Trial RegistrationClinicalTrials.gov Identifier: NCT02434614

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Optimizing induction chemotherapy regimens for radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma

et al. 2023

Cancer Medicine

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Background and Purpose The optimal number of cycles of induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (LANPC) remains unresolved. This study aimed to quantitatively assess the changes in gross tumor volumes (GTVs) and to select the most optimal number of IC cycles. Methods We analyzed 54 patients who received a three‐cycle IC before commencing radiotherapy, with the tumor and nodal responses assessed by a CT scan before IC and after each IC cycle. The gross tumor volumes of the nasopharynx primary lesion (GTV_T), involved retropharyngeal lymph node (GTV_RP), and involved cervical lymph node (GTV_N) were contoured on each scan. The volume change following each IC cycle was evaluated with Wilcoxon signed‐rank test. The three‐dimensional vector displacements of target centers were also calculated and compared. Results The volume reductions of GTVs following IC varied across different patients and showed different trends for the three GTV types. GTV_T and GTV_RP did not display further volume reduction after two IC cycles, whereas GTV_N showed monotonic volume decreases. For GTV_T and GTV_RP following the three IC cycles, the total volume reduction relative to the initial volume before IC was 12.0%, 22.5%, and 20.1% and 26.0%, 44.1%, and 42.2%, respectively. In contrast, for GTV_N, continuing volume reduction was observed with a total reduction of 25.3%, 43.2%, and 54.7% following the three cycles, and the reductions were all significant. Average displacements of the GTVs were <1.5 mm in all directions; their average three‐dimensional displacements were 2.6, 4.0, and 1.7 mm, respectively. Acceptable toxicity was observed in most patients. Conclusion This study supports two cycles of IC before radiotherapy for patients with LANPC if the initial metastatic cervical lymph node volume is not dominating. Otherwise, three cycles of IC is recommended to further reduce the cervical node volume.

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A phase II study of induction carboplatin and gemcitabine followed by chemoradiotherapy for the treatment of locally advanced nasopharyngeal carcinoma

Cited by 29 publications

References 19 publications

Evaluation of the efficacy and safety of a neoadjuvant gemcitabine and nedaplatin regimen followed by radiotherapy or concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

Evaluation of the efficacy and safety of a neoadjuvant gemcitabine and nedaplatin regimen followed by radiotherapy or concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma

Induction Chemotherapy Followed by Radiotherapy vs Chemoradiotherapy in Nasopharyngeal Carcinoma

Optimizing induction chemotherapy regimens for radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma

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