Combination Treatment With Paclitaxel, Carboplatin, and Cetuximab (PCE) as First-Line Treatment in Patients With Recurrent and/or Metastatic Nasopharyngeal Carcinoma

Abstract

Background: Platinum-containing doublet chemotherapy regimens are generally considered the standard first-line systemic therapy for recurrent or metastatic (R/M) nasopharyngeal cancer (NPC). Gemcitabine (GEM) plus cisplatin (CDDP) has become a standard therapy based on a phase 3 study in several countries, yet this regimen sometimes affects quality of life due to nausea or appetite loss. Here, we present the manageable toxicity and promising activity of paclitaxel + carboplatin + cetuximab (PCE) therapy for R/M NPC. Materials and Methods: We conducted a retrospective review of patients with R/M NPC who were treated with PCE from 2013 to 2019 at the National Cancer Center East, Kashiwa, Japan. PCE consisted of PTX 100 mg/m 2 on days 1 and 8; CBDCA area under the blood concentration-time curve (AUC) 2.5 on days 1 and 8, repeated every 3 weeks; and cetuximab at an initial dose of 400 mg/m 2 , followed by 250 mg/m 2 weekly, as reported in the paper. Results: Fourteen patients were identified, consisting of 10 males and 4 females with a median age 59.6 years (range, 43-74). Among the 12 of 14 patients assessed for efficacy, overall response rate was 58.3%, with 2 complete responses and 5 partial responses. On median follow-up of 23.8 months, median overall survival was not reached with observed death events of 2. Median PFS was 4.1 months (95% CI, 2.6-5.6 months). Two patients experienced disease progression during cetuximab maintenance and restarted PCE treatment, then achieved partial response again. The most common grade 3 or 4 adverse events were neutropenia (21.4%) and skin reaction (14.3%). No treatment-related death was observed. Conclusion: Although the number of study population was small, our results suggest that PCE is feasible and potentially effective for R/M NPC, with a 58.3% response rate and 4.1-month PFS. Further prospective evaluation is warranted.

Induction chemotherapy with paclitaxel, carboplatin and cetuximab for locoregionally advanced nasopharyngeal carcinoma: A single-center, retrospective study

“…Given the frequency of epidermal growth factor receptor (EGFR) expression on NPC, in 73.3-84.1% of cases ( 17 – 20 ), several studies evaluated treatment with anti-EGFR therapy in collaboration with CRT for LA-NPC ( 21 – 23 ) and with chemotherapy for R/M NPC ( 15 , 24 – 26 ), and reported promising clinical efficacy against these diseases. As an example of the former, Hao et al.…”

“…These suggest that Cmab-containing regimens may be worth testing in anticipation of an improved prognosis. Indeed, we recently reported that the PCE regimen was effective even in patients with R/M NPC (n=14), among whom 92% of evaluable patients experienced tumor shrinkage, with ORR and CR rates of 58.3% and 16.7%, respectively ( 15 ). However, no study has evaluated IC-PCE in the treatment of LA-NPC.…”

“…Results showed that PCE as IC(IC-PCE) was feasible and effective, with a response rate of 88.6% by IC, and had no effect on compliance with subsequent CRT with CDDP. Further, PCE has shown promising efficacy in recurrent or metastatic NPC (R/M NPC), represented by an overall response rate (ORR) of 58.3% ( 15 ).…”

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

“…In R/M NPC patients, the clinical trial demonstrated that Paclitaxel Carboplatin plus Cetuximab (PCE) could achieve a 58.3% ORR rate, with better efficacy and acceptable side effects. It is worth mentioning that patients can receive this treatment on an outpatient basis [ 99 ]. The combination of CTX has become one of the first-line treatment options for patients with advanced nasopharyngeal carcinoma.…”

Epidemiology and Outcomes of Nasopharyngeal Carcinoma

“…In a number of centers, Ueda and colleagues [82] investigating a combination treatment of carboplatin, paclitaxel and cetuximab in patients with metastatic or recurrent or with repeated platinum-resistant NPC showed good survival benefit, an overall response rate reach to 64 % and a median OS of 29.1 months with follow up for 30 months. The treatment with gefitinib had little response rates in metastatic and recurrent NPC treated previously with platinum-based chemotherapy.…”