Gemcitabine And Cisplatin Followed by Chemo-Radiation for Advanced Nasopharyngeal Carcinoma

Abstract

Concurrent chemo-radiation (CRT) has been established as the standard of care for non-metastatic locoregionally advanced nasopharyngeal carcinoma (NPC) but recently the addition of induction chemotherapy in the already established regimen has presented an attractive multidisciplinary approach. This retrospective study was carried out to evaluate the efficacy of induction chemotherapy (IC) followed by CRT for the management of loco-regionally advanced NPC. Between July 2005 and September 2010, 99 patients were treated with cisplatin based IC followed by CRT. Induction chemotherapy included a 2 drug combination; intravenous gemcitabine 1000 mg/m 2 on day 1 and 8 and cisplatin 75 mg/m 2 on day 1 only. Radiotherapy (RT) was given as a phase treatment to a total dose of 70 Gy in 35 fractions. Concurrent cisplatin (75 mg/m 2 ) was administered to all patients on days 1, 22 and 43. All patients were evaluated for tumor response and adverse effects after IC and 6 weeks after the completion of the treatment protocol. Statistical analysis was performed using SPSS version 17 and Kaplan Meier estimates were applied to project survival. Median follow-up duration was 20 months. The 5-year overall survival (OS), loco regional control (LRC) and relapse free survival (RFS) rates were 71%, 73% and 50%respectively. Acute grade 4 toxicity related to induction chemotherapy and concurrent chemo-radiation was 4% and 2% respectively, with only 3 toxicity-related hospital admissions. We conclude that induction gemcitabine and cisplatin followed by chemo-radiation is a safe and effective regimen in management of nasopharyngeal carcinoma, meriting further investigation in randomized clinical trials.

Selective Radiotherapy after Distant Metastasis of Nasopharyngeal Carcinoma Treated with Dose-Dense Cisplatin plus Fluorouracil

“…NPC was also sensitive to chemotherapy, whether dose-dense chemotherapy could bring the same clinical benefit as patients with breast cancer? Our study showed that the CR rate was 19.2% after dose-dense chemotherapy, which was higher than 15% reported by Jamshed (2014), and was significantly higher than that (3.9%) of traditional chemotherapy. The rate of CR (3.9%) and PR (53.0%) in control group was similar with 4.3% and 51.7% reported by Zeng (2014).…”

Five-Year Follow-Up of Concomitant Accelerated Hypofractionated Radiation in Advanced Squamous Cell Carcinoma of the Buccal Mucosa: A Retrospective Cohort Study

“…Jamshed and colleagues in their study on treatment of locoregionally advanced nasopharyngeal carcinoma have used Gemcitabine and Cisplatin as induction chemotherapy. They have shown that 15% of patients had complete response after induction chemotherapy with good patient compliance and acceptable toxicity [ 19 ]. In the present study Gemcitabine was given in combination with Cisplatin as induction chemotherapeutic drug, which showed complete response in 18% patients.…”

Hsp90 Inhibitor Geldanamycin Enhances the Antitumor Efficacy of Enediyne Lidamycin in Association with Reduced DNA Damage Repair

“…However, the unique mechanism of Hsp90 inhibitors has been the ideal medicine against cancer or virus. Some researchers concluded that combination of chemotherapy drug and chemo-radiation was a safe and effective regimen in management of cancer, meriting further investigation in randomized clinical trials (Jamshed et al, 2014). LDM in our research was a radiomimetic enediyne anticancer drug and showed great effect in combination with Hsp90 inhibitor which was also a good selection in the drug combination.…”