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

Abstract

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.

<p>NACT + IMRT versus NACT + IMRT + CCRT in locoregionally advanced NPC patients: a retrospective study</p>

“…Our previous study investigated combination of NDP and GEM as neoadjuvant regimens in locoregionally advanced NPC patients. Unfortunately, their combination showed similar therapeutic effect compared with CBP + GEM or CDDP + GEM 28. In patients who received CCRT or NACT followed by radiation, the use of NACT is increasing 29.…”

Tumor Volume Reduction After Gemcitabine Plus Cisplatin Induction Chemotherapy in Locally Advanced Nasopharyngeal Cancer: Comparison with Paclitaxel and Cisplatin Regimens

“…The incidence of grade I–II liver toxicity was higher in the GP group than in the TP group; however, this difference was not statistically significant. In another study using gemcitabine and nedaplatin as IC, the incidences of grade I–II and grade III-IV liver dysfunction reached 53% and 9.3%, respectively, suggesting that liver function should be closely monitored during gemcitabine-based chemotherapy [ 26 ]. During CCRT, the common toxicities, including mucositis, dermatitis, and xerostomia, did not differ between the 2 groups.…”