Intensity-modulated radiotherapy plus nimotuzumab with or without concurrent chemotherapy for patients with locally advanced nasopharyngeal carcinoma

Abstract

ObjectiveThis study aimed to evaluate the safety and efficacy of intensity-modulated radiotherapy (IMRT) plus nimotuzumab with or without concurrent chemotherapy (CCT) for patients with locally advanced nasopharyngeal carcinoma (LA-NPC).Patients and methodsA total of 50 newly diagnosed patients with LA-NPC treated at the Affiliated Hospital of Jiangnan University between November 2011 and January 2017 were retrospectively analyzed. All patients received the combined treatment modality of nimotuzumab plus IMRT. Nimotuzumab was administered concurrently with IMRT at a weekly dose of 200 mg. Neoadjuvant, concurrent or adjuvant chemotherapy with the doublet regimen of taxanes (docetaxel or paclitaxel) plus platinum (cisplatin or nedaplatin) were administered. Among the 50 patients, 43 (86.0%) received ≥6 cycles of nimotuzumab (median 7 cycles, range 2–14 cycles) and 29 (58.0%) received two cycles of CCT with docetaxel plus nedaplatin.ResultsWith a median follow-up of 28.0 months, the 2-year progression-free survival (PFS) and overall survival were 83.29% (95% confidence interval [CI]: 67.93%–91.72%) and 97.67% (95% CI: 84.62%–99.67%), respectively. Both univariate and multivariate analyses revealed that cycles of nimotuzumab were significantly associated with PFS. Patients who received ≥6 cycles of nimotuzumab showed a better PFS than those receiving <6 cycles (P=0.006), whereas the addition of CCT failed to improve PFS. Oral mucositis was the most common adverse event, which was recorded as grade 3–4 in 18 (36.0%) patients. Besides, two (4.0%) patients experienced nimotuzumab-related anaphylaxis, and no skin rash was found in any patient. Subgroup analysis revealed that the patients who received CCT had more grade 3–4 adverse events as compared to those who did not receive CCT (62.1% vs 33.3%, P=0.045).ConclusionThe regime of nimotuzumab plus IMRT for the treatment of LA-NPC was well tolerated, with encouraging survival data, and it could be an effective treatment alternative for patients with LA-NPC. Further clinical trials are needed to confirm these findings.

Radiosensitivity enhancement by combined treatment of nimotuzumab and celecoxib on nasopharyngeal carcinoma cells

“… 6 , 7 Nimotuzumab, a humanized monoclonal antibody against EGFR, has been shown to yield promising clinical outcomes when combined with radiotherapy in patients with LA-NPC. 8 , 9 Nevertheless, no evidence of locoregional control or overall survival benefit was observed in the nimotuzumab-based studies as compared to the conventional regime of concurrent chemoradiation.…”

Advances in targeted therapy mainly based on signal pathways for nasopharyngeal carcinoma

“…It has been found that the progressionfree survival (PFS) and overall survival (OS) of patients administered with nimotuzumab (NTZ) and intensity-modulated radiotherapy (IMRT) were significantly prolonged comparing with patients without adjuvant chemotherapy, and patients treated with cetuximab (CTX) and concurrent chemoradiotherapy (CCRT) had a significant improvement in OS, PFS and distant metastasisfree survival comparing with patients without cetuximab, but there is no significant difference in OS between anti-EGFR therapy using CTX/NTZ combined with palliative chemotherapy (PCT) and single PCT treatment. [177][178][179][180] For EGFR pathways, apart from directly targeting EGFR for NPC treatment, targeting DLC-1, as well as a combination of EGFR targeting inhibitors with chemoradiotherapy may be potential therapeutic strategies for NPC.…”

Efficacy of concurrent chemoradiotherapy combined with nimotuzumab for low-risk T4 stage nasopharyngeal carcinoma

“…After intravenous injections of 50, 100, 200, and 400 mg, the elimination half-life of Nimotuzumab were 62.92, 82.60, 302.95, and 304.52 hours. [ 11 , 12 ] In order to ensure the plasma concentration of nimotuzumab once a week, we chose to synchronized 200 mg nimotuzumab combined with chemoradiotherapy.…”