Chemotherapy for nasopharyngeal carcinoma a ten-year experience

Decker, David A.; Drelichman, Anibal; Al‐Sarraf, Muhyi; Crissman, John D.; Reed, Melvin L.

doi:10.1002/1097-0142(19830815)52:4<602::aid-cncr2820520404>3.0.co;2-6

Cited by 107 publications

(22 citation statements)

References 9 publications

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“…The averaged response rate was 59.6% (95% CI 54-65%) and the CR rate was 17.6% (95% CI 13.3-21.9%) (Table 5) (Decker et al, 1983;Boussen et al, 1991;Choo et al, 1991;Cvitkovic et al, 1991;Mahjoubi et al, 1992;Gebbia et al, 1993;Su et al, 1993;Chi et al, 1994Chi et al, , 1995Yeo et al, 1996;Fountzilas et al, 1997). Cases with complete remission had relatively long survival, especially cases with bone metastasis Su et al, 1993), but the prognosis of non-responders were grave (Hsu et al, 1983).…”

Section: Discussionmentioning

confidence: 99%

Induction with mitomycin C, doxorubicin, cisplatin and maintenance with weekly 5-fluorouracil, leucovorin for treatment of metastatic nasopharyngeal carcinoma: a phase II study

Hong

Sheen

et al. 1999

Br J Cancer

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The combination of cisplatin and 5-fluorouracil (5-FU) (PF) is the most popular regimen for treating metastatic nasopharyngeal carcinoma (NPC) but it is limited by severe stomatitis and chronic cisplatin-related toxicity. A novel approach including induction with mitomycin C, doxorubicin and cisplatin (MAP) and subsequent maintenance with weekly 5-FU and leucovorin (FL) were designed with an aim to reduce acute and chronic toxicity of PF. Thirty-two patients of NPC with measurable metastatic lesions in the liver or lung were entered into this phase II trial. Mitomycin C 8 mg m −2 , doxorubicin 40 mg m −2 and cisplatin 60 mg m −2 were given on day 1 every 3 weeks as initial induction. After either four courses or remission was achieved, patients received weekly dose of 5-FU 450 mg m −2 and leucovorin 30 mg m −2 for maintenance until disease progression. With 105 courses of MAP given, 5% were accompanied by grade 3 and 0% were accompanied by grade 4 stomatitis. The dose-limiting toxicity of MAP was myelosuppression. Forty per cent of courses had grade 3 and 13% of courses had grade 4 leukopenia. No grade 3 or 4 cisplatin-related toxicity was observed. The overall response rate was 94% (95% confidence interval (CI) 84.9–100%) with a complete response rate (CR) of 6% (95% CI: 0–15.2%) and a good partial response (PR) rate of 28% (95% CI 11.7–44.6%), which was optionally defined as observance of only equivocal lesion identifiable under imaging study. Twenty-seven cases entered weekly FL maintenance phase. The median duration of maintenance with weekly FL was 38 weeks (8–91 weeks). There was no grade 3 or 4 toxicity noted during weekly FL. The median progression-free survival and overall survival were 11.6 ± 0.4 and 18.1 ± 3.6 months respectively. Six patients with a median follow-up of 19.8 months (9.6–41.0 months) were still alive and five of them had disease under control with FL. Good responders (CR and good PR) had better survival than less satisfactory responders (PR and stable disease) ( P = 0.05). From Cox’s multivariate regression analysis, the only significant prognostic factor for survival was good response to MAP ( P = 0.042). Liver metastasis was the only significant variable in the best subset regression model that predicted good response to MAP (CR and good PR) ( P = 0.027). MAP was an effective combination for metastatic NPC with minimal stomatitis and cisplatin-related toxicity but had significant myelosuppression. Weekly FL was a maintenance therapy with minimal side-effects. The response rate and overall survival of MAP-FL were better than series previously reported even when a subset of patients with poor prognosis was selected. MAP-FL's role as neoadjuvant or adjuvant therapy is worthy of further study. © 1999 Cancer Research Campaign

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Section: Discussionmentioning

confidence: 99%

Induction with mitomycin C, doxorubicin, cisplatin and maintenance with weekly 5-fluorouracil, leucovorin for treatment of metastatic nasopharyngeal carcinoma: a phase II study

Hong

Sheen

et al. 1999

Br J Cancer

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“…Less active agents include 5-fluorouracil (5-FU), cyclophosphamide, and vinca alkaloids. Combination agents (especially cisplatin-based regimens) are very effective [18,19]. The most widely used regimen is cisplatin 80 mg/m 2 to 100 mg/m 2 on day one and 5-FU infusion at 1000 mg/m 2 per day for 4 to 5 days.…”

Section: Radiation Therapymentioning

confidence: 99%

Nasopharyngeal carcinoma

Sarraf

Reddy

2002

Curr. Treat. Options in Oncol.

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Nasopharyngeal carcinoma is usually present as locally advanced (stage III or IV) disease. Before 1980, the primary treatment was radiotherapy. The 5-year survival rate of patients with stage IVM0 across the world was less than 30%. Local, regional, and systemic recurrences are high in these patients and contributed to the poor survival. Sequential chemotherapy followed by radiotherapy (especially with the combination of cisplatin and 5-fluorouracil infusion for three courses) resulted in a 5-year survival rate of up to 55% in patients with stage IV disease. Concurrent single-agent cisplatin and radiotherapy improved 5-year survival rate to up to 55% in these patients. Total treatment with concurrent chemoradiotherapy followed by adjuvant cisplatin and 5-fluorouracil infusion resulted in 5-year survival rate of approximately 75%. Reversing the sequence of treatment by giving chemotherapy followed by concurrent chemoradiotherapy may improve the 5-year survival to up to 90%. In patients with recurrent disease or systemic metastases, the chances of salvage and long remission (many years) is approximately 15% to 20% with the use of adequate and effective chemotherapy. Newer agents, alone or concomitant with radiotherapy, are being evaluated in these patients.

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“…• The rationale for the addition of chemotherapy to the standard radiotherapy approaches used to treat locally advanced NPC that led to the development of Int 0099 was derived from many local and cooperative group phase II trials, including our own [5,6]. Perhaps the most compelling motivation, however, came from a subset analysis of NPC patients undergoing concurrent chemoradiation who were part of a Radiation Therapy Oncology Group (RTOG) trial for patients with advanced, unresectable SCC of the head and neck [58].…”

Section: Treatmentmentioning

confidence: 99%

“…The more common Asian variety has a 3-4:1 male to female ratio and begins earlier in life with a peak incidence in the 40 to 50 year age group [1][2][3]. Compared with other head and neck cancers, NPC has higher propensity for both nodal (80%) and distant (30%) metastasis [5,6]. Isolated neck nodes are therefore a common mode of presentation.…”

Section: Introductionmentioning

confidence: 99%

Locally advanced nasopharyngeal cancer

Ensley

Youssef

Kim

et al. 2001

Curr. Treat. Options in Oncol.

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The Head and Neck Cancer Intergroup phase III clinical trial (Int 0099) for patients with locally advanced, squamous cell carcinomas (SCC) of the nasopharynx (or NPC) has been recently completed in the United States. The results of this study have defined the new standard of treatment for the group of patients studied. Patients with untreated, locally advanced stages III and IV NPC were randomized to a conventional course of radiation, or to radiation given concurrently with chemotherapy followed by three courses of combination chemotherapy. The 3-year progression-free survival (PFS) and overall survival (OS) were 24% versus 69% (P < 0.001) and 46% versus 76% (P < 0.001) for the control and experimental groups, respectively. Recent updates of these survival figures show that they have not changed appreciably. The considerable improvement in OS versus PFS for the patient group receiving radiation alone is accounted for primarily by re-treatment with concurrent radiation-chemotherapy, combination chemotherapy, and isolated salvage neck dissections. Highly significant differences in local control (41% vs 14%) and distant metastases (35% vs 13%) were demonstrated in favor of the chemoradiation treatment arm. The median age for these patients was 51 years, with a 2:1 male to female ratio. Although many patients had a significant history of tobacco exposure with or without alcohol use or abuse, only 24% had keratinizing or well-differentiated squamous (World Health Organization I) type tumors. Whether these results can be extrapolated to the more common Asian variety (WHO II and III) of advanced NPC must be addressed in future clinical trials.

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Chemotherapy for nasopharyngeal carcinoma a ten-year experience

Cited by 107 publications

References 9 publications

Induction with mitomycin C, doxorubicin, cisplatin and maintenance with weekly 5-fluorouracil, leucovorin for treatment of metastatic nasopharyngeal carcinoma: a phase II study

Induction with mitomycin C, doxorubicin, cisplatin and maintenance with weekly 5-fluorouracil, leucovorin for treatment of metastatic nasopharyngeal carcinoma: a phase II study

Nasopharyngeal carcinoma

Locally advanced nasopharyngeal cancer

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