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He J, Luo G, Liu S, Chen L, Chen Z, Zhang B, Lin J, Qin W, Li H, Zhou H, Yu Y, Zhan D, Yang D, Luo H. Tislelizumab plus neoadjuvant chemotherapy and concurrent chemoradiotherapy versus neoadjuvant chemotherapy and concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: A retrospective study. Transl Oncol 2024; 48:102058. [PMID: 39079408 PMCID: PMC11339050 DOI: 10.1016/j.tranon.2024.102058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/30/2024] [Accepted: 07/05/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND The efficacy of immunotherapy plus neoadjuvant chemotherapy and concurrent chemoradiotherapy (CCRT) for locally advanced nasopharyngeal carcinoma (LA-NPC) has not been reported. This study retrospectively compared the efficacy of tislelizumab plus neoadjuvant chemotherapy and CCRT with neoadjuvant chemotherapy followed by CCRT. METHODS Ninety patients with stages III-IVa NPC were identified between January 2020 and March 2021 at the Affiliate Hospital of Guangdong Medical University. Forty-three patients in the observation group (OG) received tislelizumab plus nano albumin-paclitaxel and cisplatin (nab-TP) regimen, followed by CCRT, while forty-seven patients in the control group (CG) received nab-TP regimen followed by CCRT. RESULTS The complete response rate after neoadjuvant therapy was significantly higher in the OG compared to the CG (37.2% vs. 12.8 %). The objective response rates were 88.4 % in the OG and 70.2 % in the CG. The 3-year progression-free survival (PFS) rates for OG and CG patients were 93.0 % and 78.7 %, respectively (P = 0.04, HR = 0.31). The overall survival (OS) rates for the OG and the CG were 95.3 % and 87.2 %, respectively (P = 0.15, HR = 0.36). Locoregional relapse-free survival (LRFS) rates were 90.7 % for the OG and 72.3 % for the CG (P = 0.04, HR = 0.38), and distant metastasis-free survival (DMFS) rates were 95.3 % for the OG, and 80.9 % for the CG (P = 0.04, HR = 0.30). For PD-L1 high-expression and low-expression rates, the 3-year PFS rates were 89.2 % and 85.7 % (P = 0.77, HR = 1.21), and the OS rates were 90.2 % and 89.2 % (P = 0.65, HR = 1.36), respectively. CONCLUSION Tislelizumab combined with neoadjuvant chemotherapy and CCRT showed encouraging therapeutic effects and good tolerability in patients with LA-NPC compared to the standard treatment.
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Affiliation(s)
- Jiaqi He
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Guoqing Luo
- Otorhinolaryngology Department of Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, PR China
| | - Shen Liu
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Lingli Chen
- The First Clinical Medical College of Guangdong Medical University, Zhanjiang 524023, PR China
| | - Zihong Chen
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Bing Zhang
- Plastic Surgery Department of Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, PR China
| | - Jiong Lin
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Wenyi Qin
- Thyroid and Breast Surgery Department of Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, PR China
| | - Haiwen Li
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Haideng Zhou
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Ying Yu
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Dechao Zhan
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Donghong Yang
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China.
| | - Haiqing Luo
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China.
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In search for optimal induction chemotherapy for advanced nasopharyngeal cancer: Standard dosing of Docetaxel, Platinum, and 5-Fluorouracil (TPF) followed by chemoradiation. PLoS One 2023; 18:e0276651. [PMID: 36730145 PMCID: PMC9894485 DOI: 10.1371/journal.pone.0276651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/26/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES A phase II = design is used to evaluate the efficacy and feasibility of full dose docetaxel, platinum, and 5-fluorouracil (TPF) in a sequential chemoradiation treatment locally advanced (LA) or oligometastatic (OM) NPC patients. MATERIALS AND METHODS Twenty patients with LANPC (M0 cohort) and six patients with OMNPC (M1 cohort) received induction standard dose T (75 mg/m2) P (75 mg/m2) F (750 mg/m2 IVCI x 5days) x 3 followed by weekly cisplatin (40 mg/m2) or carboplatin (AUC 1.5) x 6 concurrent with radiation therapy of 70 Gy over 6.5-7 weeks. The first five patients received bevacizumab as part of an exploratory objective of hypoxia modification using correlative fluoromisonidasole (18F-MISO) PET CT scanning. RESULTS The 18F-MISO imaging failed to reveal adequate levels of baseline hypoxia necessary to evaluate for changes with chemotherapy and bevacizumab. Ninety percent of M0 patients and 83% of M1 patients received the full-intended TPF and radiation dose. Eighty-five percent of M0 patients and all M1 patients received at least 60% of the full-intended concurrent platinum dose. The 2-year progression free survival (PFS) rate for the M0 cohort was 90% (95% CI: 77.8%- 100%), and was sustained at 5 years. The 2-year PFS rate for the M1 cohort was 66.7% (95% CI: 37.9%- 100%). The 2-year overall survival (OS) rates for the M0 and M1 cohorts were 100% and 83.3% (95% CI: 58.3%- 100%), respectively. At five years, OS was 94.4% for the M0 cohort. CONCLUSION Administration of standard-dose TPF as induction chemotherapy in this NPC patient population is both feasible and effective when coupled with definitive concurrent chemoradiation. CLINICALTRIALS.GOV IDENTIFIER NCT00896181.
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Li WZ, Wu G, Li TS, Dai GM, Liao YT, Yang QY, Chen F, Huang WY. Dynamic contrast-enhanced magnetic resonance imaging-based radiomics for the prediction of progression-free survival in advanced nasopharyngeal carcinoma. Front Oncol 2022; 12:955866. [PMID: 36338711 PMCID: PMC9627984 DOI: 10.3389/fonc.2022.955866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/05/2022] [Indexed: 08/30/2023] Open
Abstract
To establish a multidimensional nomogram model for predicting progression-free survival (PFS) and risk stratification in patients with advanced nasopharyngeal carcinoma (NPC). This retrospective cross-sectional study included 156 patients with advanced NPC who underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Radiomic features were extracted from the efflux rate constant (Ktrans ) and extracellular extravascular volume (Ve ) mapping derived from DCE-MRI. Least absolute shrinkage and selection operator (LASSO) Cox regression analysis was applied for feature selection. The Radscore was constructed using the selected features with their respective weights in the LASSO Cox regression analysis. A nomogram model combining the Radscore and clinical factors was built using multivariate Cox regression analysis. The C-index was used to assess the discrimination power of the Radscore and nomogram. The Kaplan-Meier method was used for survival analysis. Of the 360 radiomic features, 28 were selected (7, 6, and 15 features extracted from Ktrans , Ve, and Ktrans +Ve images, respectively). The combined Radscore k trans +Ve (C-index, 0.703, 95% confidence interval [CI]: 0.571-0.836) showed higher efficacy in predicting the prognosis of advanced NPC than Radscore k trans (C-index, 0.693; 95% CI, 0.560-0.826) and Radscore Ve (C-index, 0.614; 95% CI, 0.481-0.746) did. Multivariable Cox regression analysis revealed clinical stage, T stage, and treatment with nimotuzumab as risk factors for PFS. The nomogram established by Radscore k trans +Ve and risk factors (C-index, 0.732; 95% CI: 0.599-0.864) was better than Radscore k trans +Ve in predicting PFS in patients with advanced NPC. A lower Radscore k trans +Ve (HR 3.5584, 95% CI 2.1341-5.933), lower clinical stage (hazard ratio [HR] 1.5982, 95% CI 0.5262-4.854), lower T stage (HR 1.4365, 95% CI 0.6745-3.060), and nimotuzumab (NTZ) treatment (HR 0.7879, 95% CI 0.4899-1.267) were associated with longer PFS. Kaplan-Meier analysis showed a lower PFS in the high-risk group than in the low-risk group (p<0.0001). The nomogram based on combined pretreatment DCE-MRI radiomics features, NTZ, and clinicopathological risk factors may be considered as a noninvasive imaging marker for predicting individual PFS in patients with advanced NPC.
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Affiliation(s)
- Wen-zhu Li
- Department of Radiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Gang Wu
- Department of Radiotherapy, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Tian-sheng Li
- Department of Radiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Gan-mian Dai
- Department of Radiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yu-ting Liao
- Department of Pharmaceutical Diagnostics, GE Healthcare, Guangzhou, China
| | - Qian-yu Yang
- Department of Radiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Wei-yuan Huang
- Department of Radiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
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Huang TC, Chen CJ, Ding YF, Kang YN. Impact of induction chemotherapy with concurrent chemoradiotherapy on nasopharyngeal carcinoma: A meta-analysis of randomized controlled trials. Front Oncol 2022; 12:965719. [PMID: 36176397 PMCID: PMC9513799 DOI: 10.3389/fonc.2022.965719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/17/2022] [Indexed: 12/08/2022] Open
Abstract
PurposeInduction chemotherapy followed by concurrent chemoradiotherapy (IC-CCRT) may be beneficial for nasopharyngeal carcinoma. However, the evidence on medium- and long-term effects of IC-CCRT is limited, and new randomized controlled trials (RCTs) have been published after 2018. Therefore, this systematic review and meta-analysis compared survival rates between patients with nasopharyngeal carcinoma receiving IC-CCRT or concurrent chemoradiotherapy (CCRT).MethodsFour databases were searched for RCTs on this topic. Two authors independently selected studies, assessed evidence, and extracted data on progression-free survival, overall survival, metastasis-free survival, and local recurrence-free survival. Available data were pooled in a random-effects model and mainly presented in hazard ratio (HR). Heterogeneity and small study effects were also evaluated.ResultsEleven RCTs (n = 3345) were deemed eligible. Pooled results revealed that patients receiving IC-CCRT had significantly improved progression-free survival (HR = 0.66, P < 0.05), overall survival (HR = 0.64, P < 0.05), metastasis-free survival (HR = 0.58, P < 0.05), and local recurrence-free survival (HR = 0.69, P < 0.05) at 3 years, but no significant difference in 5-year overall survival was noted between IC-CCRT and CCRT (HR = 0.84, P > 0.05). Most findings had low heterogeneity.ConclusionIC-CCRT may benefit patients with nasopharyngeal carcinoma in the medium term, although no significant difference was observed in 5-year survival compared with CCRT. All outcomes had decreased survival rate from the 3-years to 5-year follow-up. Differences in patient ethnicities and regimens of IC-CCRT may be sources of heterogeneity.
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Affiliation(s)
- Ting-Chieh Huang
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chi-Jen Chen
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yi-Fang Ding
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Yi-Fang Ding, ; Yi-No Kang,
| | - Yi-No Kang
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- *Correspondence: Yi-Fang Ding, ; Yi-No Kang,
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Luo Y, Cai B, Li B, Liu F, Du L, Zhao D, Fan W, Meng L, Zhang X, Ma L. The Acute Toxicities and Efficacy of Concurrent Chemotherapy With Docetaxel Plus Cisplatin, or Docetaxel, or Cisplatin and Helical Tomotherapy in Patients With Locoregionally Advanced Nasopharyngeal Carcinoma: A Randomized Single-Center Phase II Trial. Technol Cancer Res Treat 2022; 21:15330338221109974. [PMID: 35770295 PMCID: PMC9251964 DOI: 10.1177/15330338221109974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Objective: The objective of this trial is to evaluate and compare the acute toxicity in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated with docetaxel plus cisplatin, or docetaxel, or cisplatin concurrently with helical tomotherapy during concurrent chemoradiotherapy (CCRT). Methods: In a prospective, single-center, open-label, randomized phase II study, after 2 cycles of induction chemotherapy with docetaxel plus cisplatin regimen, 125 patients with LA-NPC (stage III and IVA, UICC eighth) diagnosed pathologically from June 2017 to November 2019 were randomized into CCRT with docetaxel plus cisplatin group (25 patients), CCRT with docetaxel group (50 patients), and CCRT with cisplatin group (50 patients). The incidence of grade 3 or 4 acute toxicities and clinical efficacy were analyzed among the 3 groups. Results: Safety evaluation was completed in all the 125 patients, during the CCRT period, 66.4% of patients completed 3 cycles of chemotherapy, 24.0% completed 2 cycles of chemotherapy, and 9.6% completed 1 cycle of chemotherapy according to the research plan. The incidence of grade 3 or 4 acute toxicity in CCRT with docetaxel plus cisplatin (DP), docetaxel (D), and cisplatin (P) groups was 88.0%, 72.0%, and 56.0%, respectively. The incidence of grade 3 or 4 acute toxicities in the DP group was significantly higher than that in the D and P groups (P = .015), no significant difference was detected between the D and P groups (P = .096). The most common toxicities were mucositis (40.0%), leukopenia (29.6%), neutropenia (26.4%), and pharyngo-esophagitis (12.0%); compared to D and P groups, DP group did not significantly improved the 3-year overall survival (96.0% vs 87.0% and 87.6%), progression-free survival (92.0% vs 79.7% and,76.9%), locoregional failure-free survival (96.0% vs 91.8% and 92.7%), and distant failure-free survival (100% vs 90.0% and 89.0%), there were no significant difference in survival data among the 3 groups (all P > .05). Conclusions: Higher survival benefits did not achieve from intensified CCRT with DP, CCRT with P or D obtained similar short-term survival outcomes with similar acceptable toxicities in LA-NPC patients.
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Affiliation(s)
- Yanrong Luo
- Medical School of Chinese PLA, Beijing, China.,Department of Radiation Oncology, 104607First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Radiation Oncology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Boning Cai
- Department of Radiation Oncology, 104607First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bo Li
- Department of Cardiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Fang Liu
- Department of Radiation Oncology, 104607First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lei Du
- Department of Radiation Oncology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Dawei Zhao
- Department of Radiation Oncology, 104607First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Wenjun Fan
- Department of Radiation Oncology, 104607First Medical Center of Chinese PLA General Hospital, Beijing, China.,Armed Police Forces Corps Hospital of Henan Province, Zhengzhou, China
| | - Linlin Meng
- Department of Radiation Oncology, 104607First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinxin Zhang
- Department of Otolaryngology, 104607First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Ma
- Department of Radiation Oncology, 104607First Medical Center of Chinese PLA General Hospital, Beijing, China
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Yang ZC, Du CC, Liu T, Liu LT, Chen QY, Guo SS, Mai HQ. Management of first-line palliative chemotherapy for post-treatment metastasis after gemcitabine plus cisplatin induction chemotherapy: Gemcitabine plus cisplatin and non-gemcitabine plus cisplatin chemotherapy. Head Neck 2021; 44:113-121. [PMID: 34716739 DOI: 10.1002/hed.26899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/08/2021] [Accepted: 10/05/2021] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND To evaluate whether patients with post-treatment metastasis are suitable for GP first-line palliative chemotherapy (PCT) after undergoing GP IC. METHODS Seven hundred and forty-six patients with post-treatment metastasis after undergoing GP IC were eligible. Survival outcomes were compared. RESULTS Significant differences in survival rates were observed between patients treated with GP and non-GP chemotherapy (2-year progression-free survival [PFS]: 0.7% vs. 9.7%). We investigated survival outcomes of patients treated with GP PCT within 2 years after undergoing GP IC, treated with GP PCT 2 years after undergoing GP IC, and those of non-GP PCT patients (2-year PFS: 0.0%, 2.3%, 9.7%). However, there was no difference in the 2-year PFS between the patients that received GP PCT 2 years after undergoing GP IC and the non-GP PCT treated patients. CONCLUSIONS GP is not recommended for patients that have received GP IC within 2 years. Two years after undergoing GP IC, GP can be considered.
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Affiliation(s)
- Zhen-Chong Yang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Chao-Chao Du
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ting Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Li-Ting Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiu-Yan Chen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shan-Shan Guo
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hai-Qiang Mai
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Chen R, Lu Y, Zhang Y, He R, Tang F, Yuan W, Li Y, Zhang X. Comparison of therapeutic efficacy and toxicity of docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy plus concurrent chemoradiotherapy and chemoradiotherapy alone in locally advanced nasopharyngeal carcinoma. Medicine (Baltimore) 2021; 100:e27475. [PMID: 34678878 PMCID: PMC8542149 DOI: 10.1097/md.0000000000027475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/20/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE In recent years, docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy plus concurrent chemoradiotherapy (CCRT) has been commonly applied for locally advanced nasopharyngeal carcinoma (LA-NPC). However, whether TPF+CCRT regimen is the best choice for LA-NPC remains unclear. This meta-analysis aims to elucidate and compare the efficacy and toxicity of TPF+CCRT versus CCRT alone for LA-NPC. METHODS Two investigators independently and systematically searched relevant studies available on PubMed, Embase, Cochrane Library, and Web of Science published before January 7, 2021. Data were extracted from eligible studies for assessing their qualities, and calculating pooled hazard ratios (HR), odds ratio (OR) and 95% confidence intervals (CI) using Review Manager software 5.3 (RevMan 5.3). RESULTS Five studies involving 759 LA-NPC patients were analyzed in the meta-analysis. Compared to CCRT alone, TPF-based IC plus CCRT significantly improved overall survival (OS) (HR = 0.53, 95% CI: 0.35-0.81, P = .003), progression-free survival (PFS) (HR = 0.63, 95% CI: 0.46-0.86, P = .004), distant metastasis-free survival (DMFS) (HR = 0.58, 95% CI: 0.39-0.86, P = .008), and locoregional failure-free survival (LRFFS) (HR 0.62, 95% CI: 0.43-0.90, P = .01). In addition, TPF-based IC plus CCRT mainly increased risks of grade 3/4 acute hematological toxicity and non-hematological toxicities like leukopenia (OR = 1.84, 95% CI: 0.42-8.03, P = .42), neutropenia (OR = 1.78, 95% CI: 0.23-13.82, P = .58), thrombocytopenia (OR = 1.76, 95% CI: 0.53-5.81, P = .35), febrile neutropenia (OR = 2.76, 95% CI: 0.07-101.89, P = .58), vomiting (OR = 18.94, 95% CI: 0.99-362.02, P = .05) and dry mouth (OR = 2.23, 95% CI: 0.22-22.57, P = .50), which were uncomplicated and manageable. CONCLUSIONS TPF + CCRT is superb than CCRT alone for the management of LA-NPC. However, TPF+CCRT increases the incidences of grade 3/4 acute hematological toxicity and some non-hematological toxicities.
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Affiliation(s)
- Ruijuan Chen
- Department of Xi’an Central Hospital, the Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yongkai Lu
- Department of Radiotherapy, Oncology Department, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yuemei Zhang
- Department of Radiotherapy, Oncology Department, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Ruixin He
- Department of Radiotherapy, Oncology Department, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Fengwen Tang
- Department of Radiotherapy, Oncology Department, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Wei Yuan
- Department of Radiotherapy, Oncology Department, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yi Li
- Department of Radiotherapy, Oncology Department, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xiaowei Zhang
- Department of Xi’an Central Hospital, the Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Reffai A, Mesmoudi M, Derkaoui T, Ghailani Nourouti N, Barakat A, Sellal N, Mallick P, Bennani Mechita M. Epidemiological Profile and Clinicopathological, Therapeutic, and Prognostic Characteristics of Nasopharyngeal Carcinoma in Northern Morocco. Cancer Control 2021; 28:10732748211050587. [PMID: 34664512 PMCID: PMC8529313 DOI: 10.1177/10732748211050587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Nasopharyngeal carcinoma is a multifactorial disease mainly affecting the
Asian and North African populations including Morocco. This study aimed to
determine the epidemiological profile of nasopharyngeal carcinoma in
Northern Morocco as well as its clinicopathological, therapeutic, and
prognostic characteristics. Methods 129 patients with nasopharyngeal carcinoma followed at the regional center of
oncology of Tangier in the period between April 2017 and July 2019, and
diagnosed elsewhere from March 2000 to February 2019, were included in this
study. Statistical analysis of the data was realized using Statistical
Package for the Social Sciences (SPSS) software. Results Nasopharyngeal carcinoma (NPC) represented 5% of all cases with a median age
of 50. The most affected age group was 40–54 years (41.1%). Of all patients,
65.9% were men and 34.1% were women with a sex ratio of 1.93 (Male/Female).
Undifferentiated nasopharyngeal carcinomas were the most common histological
type affecting 96.12% of patients. At diagnosis, the majority of patients
(82.2%) had an advanced stage of NPC (III, VIa, b, c) including 5.4% of
metastatic cases (IVc). Most cases (86%) had lymph node involvement with
cervical mass being the most common clinical presentation. 81.4% of patients
received radiotherapy combined with chemotherapy. Among these patients,
54.3% had concurrent radiochemotherapy preceded by induction chemotherapy.
The 5-year overall survival (OS) was 86.8% for all patients. It represented
91.3% for early stages, 87.9% for locally advanced stages, and 57.1% for the
metastatic stage significantly. The disease-free survival (DFS) at 5 years
was 87.6% knowing that relapse occurred in 16 cases. Conclusions Nasopharyngeal carcinoma is a particular disease with a late declaration. It
is common in Morocco as is the case in other endemic areas with a high
prevalence. Patients’ survival is significantly influenced by disease
staging.
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Affiliation(s)
- Ayman Reffai
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
| | - Mohamed Mesmoudi
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco.,Ahmed Ben Zayed Al Nahyan Center of Cancer Treatment, Tangier, Morocco
| | - Touria Derkaoui
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
| | - Naima Ghailani Nourouti
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
| | - Amina Barakat
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
| | - Nabila Sellal
- Ahmed Ben Zayed Al Nahyan Center of Cancer Treatment, Tangier, Morocco
| | - Parag Mallick
- Canary Center for Cancer Early Detection, School of Medicine, 10624Stanford University, Stanford, CA, USA
| | - Mohcine Bennani Mechita
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
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Fei Q, Chen HB, Zhang CM, Xu JJ, He X, Chen SW. The efficacy and safety of gemcitabine-based induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation: A meta-analysis. Medicine (Baltimore) 2021; 100:e25398. [PMID: 33832134 PMCID: PMC8036042 DOI: 10.1097/md.0000000000025398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/15/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To assess the efficacy and toxicity of gemcitabine-based induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in locally advanced nasopharyngeal carcinoma (LA-NPC). METHODS Both observational studies (OBS) and randomized controlled trials (RCT) were included in the meta-analysis. Systematic online searches were conducted in Web of Sciences, PubMed, Embase, meeting proceedings and ClinicalTrials.gov from the inception to May 25, 2020. The primary endpoint of interest was overall survival. RESULTS five OBSs and 2 RCTs including 1680 patients were incorporated in the analysis. The evidence from the RCTs showed that adding gemcitabine-based induction chemotherapy to CCRT significantly improved progression free survival (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.40-0.88; P = .010; chi square P = .25; I2 = 24%) and overall survival (HR: 0.47; 95% CI: 0.28-0.80; P = 0.005; chi square P = .49, I2 = 0%) and was related to a higher risk of hematological toxicities. Furthermore, based on the data of OBSs, overall survival (HR: 0.52; 95% CI: 0.31-0.88; P = .02; chi square P = .37, I2 = 6%) was significantly improved in patients treated with gemcitabine-based induction chemotherapy compared to those treated with taxane-based induction chemotherapy. However, the progression free survival (HR: 0.67; 95% CI: 0.45-1.01; P = .06; chi square P = .74; I2 = 0%) showed no significant difference. CONCLUSIONS For LA-NPC patients, adding gemcitabine-based induction chemotherapy to CCRT significantly improved overall survival and progression free survival with a higher risk of hematological toxicities when compared to CCRT alone. Also, gemcitabine-based regimen could be used as an alternative induction chemotherapy regimen to taxane-based regimen in the treatment of LA-NPC.
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Affiliation(s)
- Qian Fei
- Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Han-Bo Chen
- The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, 42 Bai Zi Ting Road, Nanjing, Jiangsu, China
| | - Chun-Mei Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Jia-Jun Xu
- Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Xia He
- The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, 42 Bai Zi Ting Road, Nanjing, Jiangsu, China
| | - Song-Wang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing
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Wei Z, Yao M, Ning S, Wu Y, Zhou X, Zhong C, Yan K, Xie Y. The Association of Single-Nucleotide Polymorphism rs13181 in ERCC2 with Risk and Prognosis of Nasopharyngeal Carcinoma in an Endemic Chinese Population. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:359-367. [PMID: 33762840 PMCID: PMC7982703 DOI: 10.2147/pgpm.s296215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/11/2021] [Indexed: 12/08/2022]
Abstract
Objective We examined whether the single-nucleotide polymorphism (SNP) rs13181 in the gene encoding excision repair cross complementation group 2 (ERCC2) is associated with the risk and prognosis of nasopharyngeal carcinoma (NPC). Methods SNPs at rs13181 were genotyped in 439 NPC patients (NPC group) and 431 age- and gender-matched cancer-free controls (control group) from a region of China where NPC is endemic, and frequencies of GG, GT and TT genotypes were compared between the two groups in the case–control study. In a subset of 365 NPC cases, SNPs were examined for potential correlation with tumor-free survival time (TFS) and overall survival (OS). Results Relative to NPC risk with a TT genotype, NPC risk was similar with GT + GG genotypes (OR 1.052, 95% CI 0.656–1.688), after adjusting for gender, age, smoking history, and immunoglobin A against Epstein-Barr virus capsid antigen (EBV-VCA-IgA) status. Univariate analysis showed that the GG or GT genotype was associated with significantly worse TFS (p<0.001) and OS (p=0.010) than the TT genotype. Prognosis was significantly worse for men than for women (TFS, p=0.045; OS, p=0.031), for T3–T4 classification than for T1–T2 (TFS, p=0.009; OS, p=0.007), for N3 than for N0+N1+N2 (TFS, p<0.001; OS, p<0.001). Based on multivariate analysis, independent risk factors for poor TFS were GG or GT genotype (HR 2.629, 95% CI 1.625–4.254, p<0.001), T3–T4 classification (HR 2.146, 95% CI 1.244–3.701, p=0.006) and N3 (HR 2.527, 95% CI 1.574–4.059, p<0.001). GG or GT genotype (HR 2.217, 95% CI 1.283–3.832, p=0.004), gender (HR 1.989, 95% CI 1.046–3.785, p=0.036), T3–T4 (HR 2.431, 95% CI 1.306–4.526, p=0.005) and N3 (HR 2.693, 95% CI 1.637–4.432, p<0.001) were independent risk factors for poor OS. Conclusion The rs13181 SNP in ERCC2 does not appear to be associated with NPC risk, but it may serve as an independent prognostic factor for NPC recurrence and death.
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Affiliation(s)
- Zhengbo Wei
- Department of Head and Neck Tumor Surgery, Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Mengwei Yao
- Graduate School of Guangxi Medical University, Nanning, People's Republic of China
| | - Sisi Ning
- Graduate School of Guangxi Medical University, Nanning, People's Republic of China
| | - Yuan Wu
- Graduate School of Guangxi Medical University, Nanning, People's Republic of China
| | - Xunzhao Zhou
- Graduate School of Guangxi Medical University, Nanning, People's Republic of China
| | - Changtao Zhong
- Graduate School of Guangxi Medical University, Nanning, People's Republic of China
| | - Kui Yan
- Graduate School of Guangxi Medical University, Nanning, People's Republic of China
| | - Ying Xie
- Life Science Institute of Guangxi Medical University, Nanning, People's Republic of China.,Key Laboratory of High-Incident-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education, Nanning, Guangxi, 530021, People's Republic of China
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Chen YP, Ismaila N, Chua MLK, Colevas AD, Haddad R, Huang SH, Wee JTS, Whitley AC, Yi JL, Yom SS, Chan ATC, Hu CS, Lang JY, Le QT, Lee AWM, Lee N, Lin JC, Ma B, Morgan TJ, Shah J, Sun Y, Ma J. Chemotherapy in Combination With Radiotherapy for Definitive-Intent Treatment of Stage II-IVA Nasopharyngeal Carcinoma: CSCO and ASCO Guideline. J Clin Oncol 2021; 39:840-859. [PMID: 33405943 DOI: 10.1200/jco.20.03237] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with stage II-IVA nasopharyngeal carcinoma (NPC). METHODS The Chinese Society of Clinical Oncology (CSCO) and ASCO convened an expert panel of radiation oncology, medical oncology, surgery, and advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2020. Outcomes of interest included survival, distant and locoregional disease control, and quality of life. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 108 relevant studies to inform the evidence base for this guideline. Five overarching clinical questions were addressed, which included subquestions on radiotherapy (RT), chemotherapy sequence, and concurrent, induction, and adjuvant chemotherapy options. RECOMMENDATIONS Evidence-based recommendations were developed to address aspects of care related to chemotherapy in combination with RT for the definitive-intent treatment of stage II to IVA NPC.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
- Yu-Pei Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | | | - Melvin L K Chua
- National Cancer Centre Singapore/Duke-NUS Medical School, Singapore
| | | | | | - Shao Hui Huang
- Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - Joseph T S Wee
- National Cancer Centre Singapore/Duke-NUS Medical School, Singapore
| | | | - Jun-Lin Yi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Sue S Yom
- University of California San Francisco, San Francisco, CA
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Chao-Su Hu
- Fudan University Shanghai Cancer Center, Shanghai, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Jin-Yi Lang
- Sichuan Cancer Hospital & Institute, Chengdu, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Quynh-Thu Le
- Stanford University School of Medicine, Stanford, CA
| | - Anne W M Lee
- The University of Hong Kong-Shenzhen Hospital, People's Republic of China, and The University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | - Nancy Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Brigette Ma
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China
| | | | - Jatin Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ying Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, and Chinese Society of Clinical Oncology, Beijing, People's Republic of China
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Lu WJ, Li G, Gao L. Colonic perforation in a nasopharyngeal carcinoma patient treated with fluorouracil: A case report. World J Clin Cases 2020; 8:1693-1697. [PMID: 32420303 PMCID: PMC7211521 DOI: 10.12998/wjcc.v8.i9.1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is a commonly encountered type of tumor. Fluorouracil (FU) is an effective treatment providing satisfactory oncologic outcomes in nasopharyngeal carcinoma patients. We describe a unique case of colonic perforation in an NPC patient treated with FU. Thus far, only two cases of intestinal perforation associated with FU treatment have been reported. We hope that the analysis of the relationship between the adverse effects of FU and physiological factors will help to reduce the incidence of colonic perforation in patients with nasopharyngeal carcinoma treated with FU.
CASE SUMMARY A 67-year-old female patient suffered from NPC stage pT3N2M0. She had a history of three surgical procedures: Partial enterectomy, partial sigmoidectomy, and sigmoidostomy. After the administration of 2.75 g FU, a bloody stool appeared and the patient developed abdominal pain. Subsequent examination indicated colitis and intestinal perforation.
CONCLUSION FU is a commonly used drug in NPC chemotherapy. The most common adverse effect of FU is gastrointestinal reaction, and the colonic perforation found here is thought to be caused by gastrointestinal mucosal injury consequential to the FU treatment. When selecting chemotherapy drugs, their side effects and the physical condition of patients should be considered, particularly in patients with a history of gastrointestinal surgery.
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Affiliation(s)
- Wei-Jia Lu
- Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Gong Li
- Department of Radiotherapy, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Lei Gao
- Department of Radiotherapy, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
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