Adding Induction Chemo to Chemoradiotherapy Improved OS in Nasopharyngeal Carcinoma

In a recent study, adding induction chemotherapy to chemoradiotherapy significantly improved recurrence-free survival (RFS) and overall survival (OS) in patients with locoregionally advanced nasopharyngeal carcinoma compared with chemoradiotherapy alone (N Engl J Med. 2019 May 31. Epub ahead of print).

“Platinum-based concurrent chemoradiotherapy is the standard of care for patients with locoregionally advanced nasopharyngeal carcinoma,” explained Yuan Zhang, MD, PhD, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China, and colleagues.

“Additional gemcitabine and cisplatin induction chemotherapy has shown promising efficacy in phase 2 trials,” they continued.

A total of 480 patients with locoregionally advanced nasopharyngeal carcinoma were enrolled in the parallel-group, multi-center, controlled, phase 3 trial by Dr Zhang et al, in which gemcitabine and cisplatin as induction chemotherapy plus concurrent chemoradiotherapy was compared with concurrent chemoradiotherapy alone.

Patients were randomized in a 1:1 ratio to receive gemcitabine plus cisplatin every 3 weeks for 3 cycles plus chemoradiotherapy (concurrent cisplatin every 3 weeks for 3 cycles plus intensity-modulated radiotherapy; n = 242) or chemoradiotherapy alone (n = 238).

The primary end point of the study was RFS (ie, no disease recurrence or death from any cause) in the intention-to-treat population, and secondary end points included OS, adherence to treatment, and safety.

For patients receiving induction chemotherapy and standard therapy, the 3-year RFS rate at a median follow-up of 42.7 months was 85.3% versus 76.5%, respectively (stratified hazard ratio [HR] for recurrence or death, 0.51; 95% CI, 0.34-0.77; P = .001). At 3-years, the OS rates were 94.6% and 90.3%, respectively (stratified HR for death, 0.43; 95% CI, 0.24-0.77).

Of note, 96.7% of the patients finished 3 cycles of induction chemotherapy.

Acute adverse events of grade 3 or 4 occurred in 75.7% of patients in the induction chemotherapy arm and 55.7% of patients in the standard-therapy arm. There were higher incidences of neutropenia, thrombocytopenia, anemia, nausea, and vomiting among recipients of induction chemotherapy versus standard therapy. Late toxic effects of grade 3 or 4 occurred in 9.2% and 11.4% of patients in the induction chemotherapy and standard therapy arms, respectively.

“Induction chemotherapy added to chemoradiotherapy significantly improved recurrence-free survival and overall survival, as compared with chemoradiotherapy alone, among patients with locoregionally advanced nasopharyngeal carcinoma,” Dr Zhang and colleagues concluded.—Hina Khaliq