Optimizing number of cycles of induction chemotherapy for patients with nasopharyngeal carcinoma: Retrospective survival analysis

He, Yan; Zhao, Zhihao; Wang, Ying; Chai, Jiamin; He, Jialing; Wang, Jingjing; He, Ling; Guan, Hui; Wei, Zhimei; Liu, Zheran; Mu, Xiaoli; Peng, Xingchen

doi:10.1002/hed.26141

Cited by 19 publications

(24 citation statements)

References 22 publications

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“…Our study showed that three cycles IC could not improve OS, DMFS, LRRFS, or PFS in LA-NPC patients, which were consistent with previous study by Wei et al 16 . The subgroup analysis further demonstrated no survival difference between the patient subgroups, regardless of pre-EBV DNA or tumor stage.…”

Section: Discussionsupporting

confidence: 93%

“…Additionally, the population of the two studies was all staged by the 7th AJCC/UICC staging system, which would lack generalizability in real-world clinical practice with the advent of the 8th staging system. A recent study by He et al compared survival outcome from patients treated with 2, 3 and 4 IC cycles and found similar survival between 2 and 3 cycles IC groups, while 4 cycles IC was associated with worse overall survival and higher incidence of treatment-related toxicities [16]. However, the above study also used the 7th staging system and included stage II patients for whom IC is not routinely recommended according to the latest guideline [35].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, IC regime failed to be an independent prognostic factor for survival outcomes. Additionally, all regimens included in this study (TPF, TP, PF, GP) were platinum-based and recommended according to the guideline, which have been widely used in many hospitals 16 , 18 , 21 . Second, the data from a single institution do not provide robust evidence.…”

Section: Discussionmentioning

confidence: 99%

“…There is no conclusive on the number of IC cycles with the greatest benefit to patient survival. Previous studies have shown that additional cycles of IC after two failed to increase survival rate for patients with LA-NPC compared with two cycles of IC, but increase a higher incidence of treatment-related toxicity [15][16][17]. It is important to identify optimal number of IC cycles in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Optimize the number of cycles of induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis

Jiang¹,

Chen²,

Yang³

et al. 2022

J. Cancer

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Background: There is no conclusive on the optimal number of cycles of induction chemotherapy (IC) with the greatest benefit to patient survival. This study aimed to assess the efficiency and acute toxicities of different cycles of IC for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Methods: We reviewed data from patients with LA-NPC treated with IC plus concurrent chemoradiation (CCRT). Propensity score matching (PSM) was applied to match paired patients. After PSM, survival outcomes of matched patients were compared between two and three cycles of IC groups. Univariate and multivariate Cox regression analysis were carried out to identify potentially independent predictors. Treatment-related acute toxicities between the two groups were compared by Pearson X 2 test or Fisher's exact test. Results: In total, 189 pairs were selected. The median follow-up time was 60 months (range 5 to 126 months). There was no difference between two and three cycles of IC in terms of 5-year overall survival (87.0% vs. 89.7%, p = 0.991), distant metastasis-free survival (90.1% vs. 86.8%, p = 0.587), locoregional recurrence-free survival (97.0% vs. 93.8%, p = 0.488), or progression-free survival (79.4% vs. 79.3%, p = 0.896). Multivariate Cox analysis showed that T stage, N stage, and clinical stage were independent prognostic factors. Three cycles of IC were associated with a higher incidence of Grade 1-2 acute toxicity than two cycles during IC period. Conclusion:The efficacy of two cycles of IC achieved similar survival outcomes as three cycles and has a lower incidence of treatment-related acute toxicity.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimize the number of cycles of induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis

Jiang¹,

Chen²,

Yang³

et al. 2022

J. Cancer

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“…During the pandemic, consideration was given on a case-by-case basis to delivering 2 instead of 3 cycles in view of data suggesting this may provide equivalent benefit. [24]…”

Section: Methodsmentioning

confidence: 99%

Keep calm and carry on: safety, feasibility and early outcomes of head and neck cancer treatment during the COVID-19 pandemic

Walker

Campbell

Hay

et al. 2020

Preprint

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Background Patients with cancer are considered at higher risk of COVID-19 infection and increased severity of infection. Anti-cancer treatment may further increase those risks. The aim of this work is to report early outcomes in patients with head and neck cancer (HNC) treated during the pandemic. Materials and Methods A retrospective cohort study in a UK tertiary level oncology centre between 1st March and 23 June 2020, including patients with HNC who were either newly diagnosed, had developed new recurrent/metastatic disease, or were already scheduled to receive treatment during that period. Results 200 patients were evaluated. Median age was 64 years, 65.5% had multiple co-morbidities, 77.5% were current or ex-smokers and 59.5% lived in areas of deprivation. 99 patients were treated with 6 weeks of radical (chemo) radiotherapy. Systemic anti-cancer treatment was delivered to 40 patients. 2 (1.0%) patients with HNC had confirmed COVID-19 infection; 1 patient prior to primary radical RT - no delay to treatment was required and RT was completed as planned, 1 patient acquired COVID-19 after primary surgery but recovered well and started adjuvant RT 9.7 weeks after surgery. The proportion of patients receiving supportive care only (19.5%) was in keeping with that pre-COVID-19. The proportion of patients not completing (chemo) radiotherapy (3.4%) or with gaps in treatment (14.1%) was similar to pre-COVID-19. 30-day mortality after radical (chemo)radiotherapy was 2.3%, no higher than in previous years. Conclusions It is feasible and safe to deliver standard treatment for patients with HNC during the COVID-19 pandemic.

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Effect of Induction Chemotherapy With Paclitaxel, Cisplatin, and Capecitabine vs Cisplatin and Fluorouracil on Failure-Free Survival for Patients With Stage IVA to IVB Nasopharyngeal Carcinoma

et al. 2022

JAMA Oncol

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added to concurrent chemoradiotherapy significantly improves survival for patients with locoregionally advanced nasopharyngeal carcinoma, but the optimal induction regimen remains unclear.OBJECTIVE To determine whether induction chemotherapy with paclitaxel, cisplatin, and capecitabine (TPC) improves survival vs cisplatin and fluorouracil (PF) prior to chemoradiotherapy for patients with stage IVA to IVB nasopharyngeal carcinoma. DESIGN, SETTING, AND PARTICIPANTSThis randomized, open-label, phase 3 clinical trial recruited 238 patients at 4 hospitals in China from October 20, 2016, to August 29, 2019. Patients were 18 to 65 years of age with treatment-naive, nonkeratinizing stage IVA to IVB nasopharyngeal carcinoma and an Eastern Cooperative Oncology Group performance status of 0 to 1.INTERVENTIONS Patients were randomly assigned (1:1) to receive induction chemotherapy with two 21-day cycles of TPC (intravenous paclitaxel [150 mg/m 2 , day 1], intravenous cisplatin [60 mg/m 2 , day 1], and oral capecitabine [1000 mg/m 2 orally twice daily, days 1-14]) or PF (intravenous cisplatin [100 mg/m 2 , day 1] and fluorouracil [800 mg/m 2 daily, days 1-5]), followed by chemoradiotherapy. MAIN OUTCOMES AND MEASURESThe primary end point was failure-free survival in the intention-to-treat population. Secondary end points included distant metastasis-free survival, locoregional relapse-free survival, overall survival, tumor response, and safety. RESULTS Overall, 238 eligible patients (187 men [78.6%]; median age, 45 years [range, 18-65 years]) were randomly assigned to receive TPC (n = 118) or PF (n = 120). The median follow-up duration was 48.4 months (IQR,. Failure-free survival at 3 years was 83.5% (95% CI, 77.0%-90.6%) in the TPC group and 68.9% (95% CI, 61.1%-77.8%) in the PF group (stratified hazard ratio [HR] for recurrence or death, 0.47; 95% CI, 0.28-0.79; P = .004). Induction with the TPC regimen resulted in a significant reduction in the risk of distant metastases (stratified HR, 0.49 [95% CI, 0.24-0.98]; P = .04) and locoregional recurrence (stratified HR, 0.40 [95% CI, 0.18-0.93]; P = .03) compared with the PF regimen. However, there was no effect on early overall survival (stratified HR, 0.45 [95% CI, 0.17-1.18]; P = .10). The incidences of grade 3 to 4 acute adverse events and late-onset toxicities were 57.6% (n = 68) and 13.6% (16 of 118), respectively, in the TPC group and 65.8% (n = 79) and 17.9% (21 of 117), respectively, in the PF group. One treatment-related death occurred in the PF group.CONCLUSIONS AND RELEVANCE This randomized clinical trial found that induction chemotherapy with 2 cycles of TPC for patients with stage IVA to IVB nasopharyngeal carcinoma improved failure-free survival compared with 2 cycles of PF, with no increase in the toxicity profile.

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Optimizing number of cycles of induction chemotherapy for patients with nasopharyngeal carcinoma: Retrospective survival analysis

Cited by 19 publications

References 22 publications

Optimize the number of cycles of induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis

Optimize the number of cycles of induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis

Keep calm and carry on: safety, feasibility and early outcomes of head and neck cancer treatment during the COVID-19 pandemic

Effect of Induction Chemotherapy With Paclitaxel, Cisplatin, and Capecitabine vs Cisplatin and Fluorouracil on Failure-Free Survival for Patients With Stage IVA to IVB Nasopharyngeal Carcinoma

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