Anti‐epidermal growth factor receptor monoclonal antibody plus palliative chemotherapy as a first‐line treatment for recurrent or metastatic nasopharyngeal carcinoma

Abstract

Background Platinum‐based chemotherapy is the standard of care as first‐line treatment for recurrent or metastatic nasopharyngeal carcinoma (RM‐NPC); however, the prognosis of patients with RM‐NPC remains poor. The aim of this study was to evaluate the role of anti‐epidermal growth factor receptor (anti‐EGFR) antibody plus chemotherapy for RM‐NPC. Methods RM‐NPC patients who received first‐line chemotherapy plus an anti‐EGFR antibody were recruited from Sun Yat‐Sen University Cancer Center between July 2007 and November 2017. Survival analyses were performed using the Kaplan‐Meier method with a log‐rank test. A Cox proportional hazards model was used for the multivariate analyses. Results A total of 203 patients were enrolled in the present study. The median follow‐up time was 34.3 months (interquartile range: 19.7‐66.5 months). The median progression‐free survival (PFS) was 8.9 months (95% CI: 7.7‐10.0 months) and the median overall survival (OS) was 29.1 months (95% CI: 23.5‐34.6 months). The 1‐, 3‐, and 5‐year PFS and OS rates were 35.5% and 79.6%, 15.2% and 42.5%, and 11.6% and 23.6%, respectively. The objective response rate (ORR) was 67.5% and the disease control rate (DCR) was 91.1%. The multivariate analysis identified the following prognostic factors for PFS: anti‐EGFR agent (P = .010), recurrence/metastasis sequence (P = .016), KPS (P = .017), and combined chemotherapy regimen (P = .015). Independent risk factors for OS included age >43 years (P = .002), Karnofsky performance score ≤80 (P < .001), and higher level of baseline Epstein‐Barr virus (EBV) DNA (P = .008). Leukopenia was the most common adverse event (AE) in this cohort (any grade, 84.2%; grades 3‐4, 43.4%). Conclusions Anti‐EGFR antibody plus chemotherapy achieved promising antitumor activity with a tolerable toxicity profile in RM‐NPC. Thus, randomized clinical trials are warranted to compare the efficacy of chemotherapy with or without anti‐EGFR antibody in these patients.

UC2288 induces cell apoptosis of nasopharyngeal carcinoma cells via inhibiting EGFR/ERK pathway

“…EGFR is upregulated in most NPC samples and combination anti-EGFR antibody with chemotherapy is an effective, promising and well-tolerated strategy for recurrent or metastatic NPC 20 , 21 . Extracellular-signal regulated kinase (ERK) is one of downstream molecules of EGFR signaling.…”

Advances in pathogenesis and precision medicine for nasopharyngeal carcinoma

“…Traditionally, radiation therapy is commonly used to treat NPC because the tumor is highly sensitive to ionizing radiation and the anatomical location where it occurs limits the surgical approach. Radiotherapy is generally effective for patients with early and nonmetastatic NPC; therefore, it is the main treatment for the nonmetastatic stages 227,228 …”

“…In a multivariate analysis, the anti‐EGFR agent was an independent prognostic factors for PFS ( P = .010). However, the benefit of anti‐EGFR antibody still warrants further evaluation in larger randomized controlled trails 227 . An ongoing phase III trial is evaluating the efficacy of nimotuzumab versus cisplatin combined with IMRT in patients with stage II‐III NPC (NCT03837808).…”

Nasopharyngeal Carcinoma: The Role of the EGFR in Epstein–Barr Virus Infection

“…Clinical trials have shown that EGFR-targeted therapy (CTX and NTZ) based on palliative chemotherapy for recurrent or metastatic NPC (R/M NPC) patients significantly increase the chance of progression-free survival (PFS). Moreover, toxic and non-toxic side effects are within a controllable range, suggesting the importance of anti-EGFR therapy in NPC treatment [ 92 ]. CTX and Panitumumab are the most widely used, neutralizing monoclonal antibodies, and inhibit receptor activation and downstream signalling.…”

“…Nevertheless, XTC-treated patients have a longer PFS than those who are NTZ-treated, and have an acceptable overall toxicity. Specifically, the toxic effects in patients treated with CTX are more common than in patients treated with NTZ [ 92 ]. The curative effect of the EGFR monoclonal antibody combined with radiotherapy, chemotherapy, and CCRT is equivalent to induction chemotherapy combined with CCRT.…”