Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial

Sun, Ying; Li, Wen Fei; Chen, Nian Yong; Zhang, Ning; Hu, Guo Qing; Xie, Fang; Sun, Yan; Chen, Xiao Zhong; Li, Jin Gao; Zhu, Xiao Dong; Hu, Chao; Xu, Xin; Chen, Yuan Yuan; Hu, Wei; Guo, Ling; Mo, Hao Yuan; Chen, Lei; Ma, Jun; Sun, Rui; Ai, Ping; Liang, Shumin; Long, Guo; Zheng, Bao Min; Feng, Xing; Gong, Xiao; Li, Ling; Shen, Chun; Xu, Jianping; Guo, Ying; Chen, Yu Ming; Zhang, Fan; Lin, Li; TANG, Ling; Liu, Meng Zhong

doi:10.1016/s1470-2045(16)30410-7

Cited by 716 publications

(830 citation statements)

References 30 publications

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“…However, these findings have not been corroborated by several other trials. A recent randomized phase III study comparing induction docetaxel, cisplatin, and fluorouracil (TPF) followed by concurrent CRT vs concurrent CRT alone showed an improved 3‐year OS with a HR of 0.54 (95% CI 0.36‐0.95, P = .02) 8. Similarly, a randomized phase II trial comparing induction docetaxel and cisplatin followed by concurrent CRT vs concurrent CRT alone showed a significantly increased 3‐year OS (HR 0.24; 95% CI 0.08‐0.73, P = .01), as well as a trend towards improved progression‐free survival and distant control 20…”

Section: Discussionmentioning

confidence: 99%

“…For example, induction chemotherapy may only be beneficial in patients with high‐risk disease, such as T3‐4 or N2‐3. The authors of the trials with positive results with induction therapy state that it has been the use of more effective induction regimen, such as TPF chemotherapy, as well as inclusion of only patients with high risk disease that has resulted in a significant OS benefit with the use of induction chemotherapy 8, 21, 22, 23. We performed a subset analysis on patients with high risk disease and found no significant survival advantage with the use of induction chemotherapy even in the most advanced stage NPC (ie T3‐4N1 or TanyN2‐3).…”

Section: Discussionmentioning

confidence: 99%

“…Patients were considered to have received induction chemotherapy if it was started ≥43 days before the start of RT. This time point was chosen as it would allow for administration of 2‐3 cycles of induction chemotherapy used in recent trials 7, 8, 10. Patients were considered to have received concurrent CRT if chemotherapy started within 21 days after the start of RT as this would allow for overlap of at least 2‐3 cycles of concurrent chemotherapy with RT.…”

Section: Methodsmentioning

confidence: 99%

“…Given that a definitive RT dose for NPC in most recent trials is 70 Gy,8, 13 we categorized patients as those receiving <70 Gy or ≥70 Gy. For the purpose of this categorization, patients receiving 69.96 Gy were considered to have received 70 Gy since 69.96 Gy is also considered to be a definitive RT dose for NPC.…”

Section: Methodsmentioning

confidence: 99%

“…Alternatively, induction chemotherapy is thought to be better tolerated and may result in early eradication of micrometastasis, leading to the hypothesis that it may result in improved survival. However, this has been controversial as several studies have found a survival benefit with this approach, while others have not 8, 9, 10. A meta‐analysis based on individual patient data has showed no benefit with induction chemotherapy 11.…”

Section: Introductionmentioning

confidence: 99%

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Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

et al. 2018

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The role of induction chemotherapy in nasopharyngeal carcinoma (NPC) remains controversial. The primary aim of this study was to use the National Cancer Database to evaluate the patterns of care of induction chemotherapy in NPC and its impact on overall survival (OS). Patients with NPC from 2004 to 2014 were obtained from the NCDB. Patients were considered to have received induction chemotherapy if it was started ≥43 days before the start of RT and concurrent CRT if chemotherapy started within 21 days after the start of RT. Propensity score matching was used to control for selection bias. Cox proportional hazards model was used to determine significant predictors of OS. Logistic regression model was used to determine predictors of the use of induction chemotherapy. Significance was defined as a P value <.05. A total of 4857 patients were identified: 4041 patients (87.2%) received concurrent CRT and 816 patients (16.8%) received induction chemotherapy. The use of induction therapy remained stable between 2004 and 2014. Younger patients and those with higher T‐ and N‐stage had a higher likelihood of being treated with induction chemotherapy. The 5‐year OS in patients treated with induction chemotherapy and CRT was 66.3% vs 69.1%, respectively (P = .25). There was no difference in OS when these two groups were analyzed after propensity score matching. No differences in OS existed between these treatment groups in patients with T3‐T4N1 or TanyN2‐3 disease (P = .76). Propensity score matching also did not reveal any difference in OS in patients with T3‐T4N1 or TanyN2‐3 disease. The use of induction chemotherapy has remained stable in the last decade. In this study of patients with NPC, induction chemotherapy was not associated with improved OS compared to CRT alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

et al. 2018

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Development of a Nomogram Model for Treatment of Nonmetastatic Nasopharyngeal Carcinoma

Zhang

Song

et al. 2020

JAMA Netw Open

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Key Points Question Could a prognostic nomogram that integrates the TNM staging system with other critical variables accurately predict overall survival and guide treatment in patients with nonmetastatic nasopharyngeal carcinoma? Findings In this cohort study of 8093 patients with nasopharyngeal carcinoma, a nomogram was developed and validated to reliably estimate overall survival, which provided significantly better discrimination than the TNM staging system. This nomogram identified 4 risk groups with differential OS rates; these 4 risk groups were associated with the efficacy of different treatment regimens. Meaning These finding suggest that this nomogram could enable individualized prognostication of overall survival and guide risk-adapted treatment for patients with nonmetastatic nasopharyngeal carcinoma.

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Multimodality Therapy for Locoregional Nasopharyngeal Carcinoma—A Decision Tool for Treatment Optimization

Rosenberg

2020

JAMA Netw Open

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Locoregional nasopharyngeal cancer (NPC) is a heterogeneous disease with variable epidemiological, clinical, and biological characteristics. Radiotherapy (RT) has become the therapeutic backbone of this disease; however, the optimal combined modality therapeutic approach remains an area of controversy. In this setting, National Comprehensive Cancer Network guidelines offer multiple treatment options that include clinical trial enrollment, concurrent systemic therapy and RT followed by adjuvant chemotherapy, induction chemotherapy followed by systemic therapy and RT, or

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Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial

Cited by 716 publications

References 30 publications

Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

Induction chemotherapy in the treatment of nasopharyngeal carcinoma: Clinical outcomes and patterns of care

Development of a Nomogram Model for Treatment of Nonmetastatic Nasopharyngeal Carcinoma

Multimodality Therapy for Locoregional Nasopharyngeal Carcinoma—A Decision Tool for Treatment Optimization

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