<p>Oral Maintenance Chemotherapy Using S-1/Capecitabine in Metastatic Nasopharyngeal Carcinoma Patients After Systemic Chemotherapy: A Single-Institution Experience</p>

Abstract

Background: In this study, we retrospectively evaluated a series of metastatic nasopharyngeal carcinoma (mNPC) patients who received oral maintenance chemotherapy using S-1/capecitabine after systemic chemotherapy and local radiation therapy, and aimed to explore potential efficient treatment strategies for this subset of patients. Patients and Methods: Thirty-seven patients with mNPC (19 newly diagnosed metastatic patients and 18 metastatic cases after definitive chemoradiotherapy) who received the treatment strategies mentioned above were analyzed. Results: After a median follow-up time of 37 months, the 3-year progression-free survival and overall survival (OS) rates were 47.6% and 87.7%, respectively. The median time to progression was 27.6 months, while the median OS was not reached at time of last follow-up. The most common acute adverse events were hematological and gastrointestinal toxicity, and all were tolerable and curable. Conclusion: Oral maintenance chemotherapy using S-1/capecitabine in mNPC patients after systemic chemotherapy could yield a superb outcome. Further multicenter prospective clinical trials are warranted.

Maintenance metronomic chemotherapy for metastatic/recurrent nasopharyngeal carcinoma

“…22 Another single-arm study also showed superb rates in their reported 3-year OS (87.7%) and PFS (47.6%) for 37 patients with metastatic NPC who received S1/capecitabine maintenance therapy after up-front systemic chemotherapy. 23 Interestingly, two prospective randomized trials from China with similar concepts and designs confirmed the value of additional maintenance chemotherapy as our results in the 2021 ASCO annual meeting. 36,37 Specifically, one study from Gaungxi, China enrolled 183 eligible patients, finding that oral S1 maintenance therapy significantly improved PFS (median: 16.2 vs. 8.7 months, p < 0.001) and OS (median: 32.1 vs. 18.2 months, p < 0.001), whereas the other study from Guangtong, China analyzed 104 randomized patients, showing that oral capecitabine maintenance therapy resulted to a significantly better PFS (HR: 0.43, 95% CI: 0.25-0.73, p = 0.001).…”

“…To date and to the best of our knowledge, our literature review found only one similar retrospective study by Sun et al 22 In that study, they explored the role of capecitabine as maintenance therapy in patients with de novo metastatic NPC, revealing a superior OS benefit as compared to the nonmaintenance therapy matching cohort in patients with low pretreatment plasma EBV DNA levels 22 . Another single‐arm study also showed superb rates in their reported 3‐year OS (87.7%) and PFS (47.6%) for 37 patients with metastatic NPC who received S1/capecitabine maintenance therapy after up‐front systemic chemotherapy 23 . Interestingly, two prospective randomized trials from China with similar concepts and designs confirmed the value of additional maintenance chemotherapy as our results in the 2021 ASCO annual meeting 36,37 .…”

“…Many studies of salvage chemotherapy over the past two decades have reported median OS durations between 11 and 28 months and median time‐to‐progression durations between 7.3 and 10 months 21 . In response, research has revealed a potential but rarely investigated approach to enhance treatment outcome for met/rec NPC by adding maintenance chemotherapy for patients with nonprogression disease to up‐front salvage chemotherapy; however, there are very few studies focusing on this approach to date 22,23 . Thus, the aim of this study was to investigate the survival impact and toxicity profiles of additional maintenance metronomic chemotherapy following intravenous (IV) chemotherapy for patients with met/rec NPC.…”

Activity and Safety of Tegafur, Gimeracil, and Oteracil Potassium for Nasopharyngeal Carcinoma: A Systematic Review and Meta-Analysis

“…Owing to its short halflife and few adverse reactions, S-1 is easy to administer and reduces the pain of intravenous fluids, thereby making patients more receptive, more tolerant, and less likely to develop drug resistance [14][15][16][17][18]. S-1 combined with chemotherapy or radiotherapy for head and neck tumors could have a good effect [19][20][21]. Moreover, when used during radiotherapy, S-1 has been associated with a low recurrence rate, satisfactory long treatment effects, and improved survival quality [9,20].…”

“…S-1 combined with chemotherapy or radiotherapy for head and neck tumors could have a good effect [19][20][21]. Moreover, when used during radiotherapy, S-1 has been associated with a low recurrence rate, satisfactory long treatment effects, and improved survival quality [9,20]. In contrast, its efficacy with chemotherapy is not satisfactory [22] and remains controversial.…”