A phase II study of concurrent cetuximab–cisplatin and intensity-modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma

Abstract

Background: Based on our previous work on the clinical activity of cetuximab in recurrent nasopharyngeal carcinoma (NPC), we evaluated the feasibility of adding cetuximab to concurrent cisplatin and intensity-modulated radiotherapy (IMRT) in locoregionally advanced NPC. Results: Thirty patients (median age of 45 years) with stage III (67%), IVA (30%) and IVB (3%) nonkeratinizing NPC were enrolled. Grade 3-4 oropharyngeal mucositis occurred in 26 (87%) patients and 10 (33%) patients required short-term nasogastric feeding. Grade 3 radiotherapy-related dermatitis occurred in six patients (20%) and three patients (10%) had grade 3 cetuximab-related acneiform rash. These grade 3-4 skin and mucosal toxic effects were manageable and reversible. At a median follow-up of 31.8 months [95% confidence interval (CI) 26.2-32.1 months], the 2-year progression-free survival was 86.5% (95% CI 74.3% to 98.8%).Conclusions: Concurrent administration of cetuximab, weekly cisplatin and IMRT is a feasible strategy against locoregionally advanced NPC. Preliminary survival data compare favorably with historic data and further follow-up is warranted.

Effectiveness and Toxicities of Intensity Modulated Radiation Therapy for Patients With T4 Nasopharyngeal Carcinoma

“…With a median follow-up of 26.8 months, satisfactory local control rate of 82.1% was achieved. Similar excellent 2-year clinical outcomes were reported by Ma et al [12]. Xiao et al [13] recently reported their long-term results of a phase II study of 81 locally advanced NPC patients.…”

“…This was relatively higher than that reported by Cao et al [12], lower than that reported by Xiao et al [13]. We attributed that to the higher percentage of patients received chemotherapy in our series than that in Cao et al [12] (100% vs. 84.3%), and the higher percentage of T4 patients in our series than that in Xiao et al [13] (100% vs. 40%). Considering all the above factors, the local control in our study is quite satisfactory.…”

“…Kwong [10] and Su [11] reported a 3-and 5-year local control rate of 100% and 97.7% for early-stage NPC treated with IMRT alone. For locoregionally advanced NPC, 2-and 5-year local control rate of 82-93% and 94.9% can be achieved after effective chemotherapy combine with IMRT [12][13][14]. Although the effectiveness of IMRT for NPC has been confirmed by number of studies, the data analyzing clinical outcomes about T4 NPC are relatively rare.…”

Nasopharyngeal Carcinoma with Bone Marrow Metastasis: Positive Response to Weekly Paclitaxel Chemotherapy

“…The combination of cetuximab and carboplatin was effective in patients with recurrent or metastatic nasopharyngeal carcinoma (28). Furthermore, two studies have reported good feasibility and encouraging survival data for cetuximab in combination with chemoradiation therapy for locoregionally advanced nasopharyngeal carcinoma (29,30). Therefore, palliative weekly chemotherapy along with cetuximab in advanced nasopharyngeal carcinoma is an attractive therapeutic option.…”

Aurora‐A activation, correlated with hypoxia‐inducible factor‐1α, promotes radiochemoresistance and predicts poor outcome for nasopharyngeal carcinoma

“…Although the EGFR mAb cetuximab has achieved survival benefits for patients with HNSCC, (12,42,43) little therapeutic improvement for those with NPC has been evident in the last two decades. Thus, the development of more EGFR-like biomarkers, which not only act as prognostic factors but also as therapeutic molecules, would lead to the improvement of individualized medicine for locally advanced NPC.…”