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Xiao L, Kang W, Liao J, Li Y. A meta-analysis comparing the efficacy and safety of gemcitabine plus cisplatin induction chemotherapy in patients with locoregionally advanced NPC. Eur Arch Otorhinolaryngol 2021; 279:2441-2450. [PMID: 34410469 DOI: 10.1007/s00405-021-07033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/04/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE Nasopharyngeal carcinoma (NPC) is a malignant tumor endangering human health. Gemcitabine or cisplatin chemotherapy has been regarded as effective treatment for patients with locoregionally advanced NPC. However, the effect of gemcitabine plus cisplatin concurrent chemoradiotherapy (CCRT) remained controversial among the studies. Therefore, we conducted this meta-analysis to assess the efficacy and safety of induction chemotherapy by gemcitabine and cisplatin (GP regimen) in patients with locoregionally advanced NPC. METHODS A systematic literature search was performed using PubMed, Web of Science, and Embase to evaluate the survival benefit and toxicity profiles of patients with locoregionally advanced NPC who were treated with CCRT. A random-effects model or a fixed-effects model was used to pool the data according to the heterogeneity among the included studies. RESULTS A total of five studies with 1286 patients met the inclusion criteria and were included in this meta-analysis. Pooled estimate showed that GP regimen was associated with significant improvements in OS (HR = 0.57, 95% CI 0.45, 0.73; P < 0.001), DFS (HR = 0.56, 95% CI 0.47, 0.66; P < 0.001), and DRFS (HR = 0.51, 95% CI 0.36, 0.73; P < 0.001), but not in LRFS (HR = 0.54, 95% CI 0.25, 1.19; P = 0.126) and ORR (RR = 1.30, 95% CI 0.54, 3.09; P = 0.556). Moreover, the incidence of adverse events of all grades (RR = 1.15, 95%CI 0.11, 1.38; P = 0.063) or grade 3-4 (RR = 0.96, 95%CI 0.57, 1.29; P = 0.385), was comparable between GP regimen and control treatments. CONCLUSION Our meta-analysis indicated that the patients with locoregionally advanced NPC could benefit from the regimen of gemcitabine plus cisplatin induction chemotherapy.
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Affiliation(s)
- Lifeng Xiao
- E.N.T. Department, Southern University of Science and Technology Hospital, 6019 Liuxian Street, Xili Avenue, Shenzhen City, 518085, Nanshan District, China
| | - Wenyi Kang
- E.N.T. Department, Southern University of Science and Technology Hospital, 6019 Liuxian Street, Xili Avenue, Shenzhen City, 518085, Nanshan District, China
| | - Jiayu Liao
- E.N.T. Department, Southern University of Science and Technology Hospital, 6019 Liuxian Street, Xili Avenue, Shenzhen City, 518085, Nanshan District, China
| | - Yuru Li
- E.N.T. Department, Southern University of Science and Technology Hospital, 6019 Liuxian Street, Xili Avenue, Shenzhen City, 518085, Nanshan District, China.
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Zang J, Xu M, Li C, Zhao L, Luo S, Wang J, Shi M. Gemcitabine and cisplatin versus docetaxel and cisplatin as induction chemotherapy followed by concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma from non-endemic area of China. J Cancer Res Clin Oncol 2020; 146:2369-2378. [PMID: 32363479 DOI: 10.1007/s00432-020-03229-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Although several trials have confirmed the treatment efficacy of induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) from endemic area of China, little is known about the best regime for induction chemotherapy in non-endemic region. This study compared the treatment effect of Gemcitabine and cisplatin (GP) versus docetaxel and cisplatin (TP) followed by concurrent chemoradiotherapy in locoregionally advanced NPC from non-endemic area of China. MATERIALS AND METHODS A total of 196 locoregionally advanced NPC patients were enrolled in this study, with 142 and 54 patients in TP and GP followed by concurrent chemoradiotherapy groups. The primary endpoint was treatment response of induction chemotherapy. The secondary endpoints included disease-free survival. The Kaplan-Meier method was used to evaluate the efficacy between treatment groups. RESULTS The median follow-up time was 45.5 months (range: 6-60.5 months). During induction chemotherapy course, GP contributed higher treatment response rate than TP (68.1% vs. 47.1%, p = 0.007). Patients in GP group had better DFS and LRFS than those in TP group (3-year and 5-year DFS, 86.8% and 82.5% vs. 71.7% and 68%, p = 0.036; 3-year and 5-year LRFS, 96.2% and 96.2% vs. 90.5% and 82.8%, p = 0.03). No significant difference of adverse events was observed between two treatment groups in the whole course. CONCLUSION This study suggested that GP followed by CCRT was better than TP followed by CCRT in improving survival outcomes of locoregionally advanced NPC patients from non-endemic area of China.
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Affiliation(s)
- Jian Zang
- Department of Radiation Oncology, XiJing Hospital, Fourth Military Medical University, No.127, Chang Le West Road, Xi'an, 710032, China
| | - Man Xu
- Department of Radiation Oncology, XiJing Hospital, Fourth Military Medical University, No.127, Chang Le West Road, Xi'an, 710032, China
| | - Chen Li
- Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, Xi'an, China
| | - Lina Zhao
- Department of Radiation Oncology, XiJing Hospital, Fourth Military Medical University, No.127, Chang Le West Road, Xi'an, 710032, China
| | - Shanuan Luo
- Department of Radiation Oncology, XiJing Hospital, Fourth Military Medical University, No.127, Chang Le West Road, Xi'an, 710032, China
| | - Jianhua Wang
- Department of Radiation Oncology, XiJing Hospital, Fourth Military Medical University, No.127, Chang Le West Road, Xi'an, 710032, China
| | - Mei Shi
- Department of Radiation Oncology, XiJing Hospital, Fourth Military Medical University, No.127, Chang Le West Road, Xi'an, 710032, China.
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Comparison of intensity-modulated radiation therapy alone vs. intensity-modulated radiation therapy combined with chemotherapy in elderly nasopharyngeal carcinoma patients (aged >65 years). Strahlenther Onkol 2019; 196:270-279. [PMID: 31748837 DOI: 10.1007/s00066-019-01533-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 10/14/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE The efficacy and tolerability of adding chemotherapy to radiotherapy in the era of intensity-modulated radiation therapy (IMRT) remain controversial among older patients with nasopharyngeal carcinoma (NPC). The present study compared IMRT alone with IMRT in combination with chemotherapy in elderly NPC patients. METHODS Between January 2011 and December 2014, 102 patients aged >65 years with NPC who received IMRT alone (IMRT group) or IMRT in combination with chemotherapy (IMRT/CT group) were enrolled. Patients from both treatment arms were pair-matched (1:1 ratio) based on six clinical factors. Differences in overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method and Cox proportional hazards models, whereas the toxicity profile was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 4. RESULTS No significant differences were noted in OS (72.1% vs. 72.5%, p = 0.799), DFS (65.9% vs. 70.1%, p = 0.733), LRRFS (76.4% vs. 71.6%, p = 0.184), and DMFS (90.8% vs. 98.0%, p = 0.610) between the IMRT and IMRT/CT groups. Multivariate analyses showed that chemotherapy was not an independent factor for OS, DFS, LRRFS, and DMFS. However, the incidences of grade 3 vomiting/nausea (p = 0.000), leukopenia/neutropenia (p = 0.000), thrombocytopenia (p = 0.041), and anemia (p = 0.040) were significantly higher in the IMRT/CT group compared with the IMRT group. No grade 4 toxicities were observed. CONCLUSION IMRT alone was similar to IMRT/CT in treating elderly NPC patients (age >65 years), with comparable survival outcomes and less grade 3 toxicities.
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Chen X, Liang W, Wan N, Zhang L, Yang Y, Jiang J, Zhang T. Cost-effectiveness analysis of gemcitabine plus cisplatin versus fluorouracil plus cisplatin for first-line treatment of recurrent or metastatic nasopharyngeal carcinoma. Oral Oncol 2019; 94:80-85. [DOI: 10.1016/j.oraloncology.2019.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/27/2019] [Indexed: 01/04/2023]
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Kong XY, Lu JX, Yu XW, Zhang J, Xu QL, Zhang RJ, Mi JL, Liao SF, Fan JF, Qin XL, Yao DC, Tang HY, Jiang W. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin as a first-line concurrent chemotherapy regimen in nasopharyngeal carcinoma: a prospective, multi-institution, randomized controlled phase II study. Cancer Chemother Pharmacol 2019; 84:155-161. [DOI: 10.1007/s00280-019-03858-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
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He Y, Guo T, Wang J, Sun Y, Guan H, Wu S, Peng X. Which induction chemotherapy regimen followed by cisplatin-based concurrent chemoradiotherapy is the best choice among PF, TP and TPF for locoregionally advanced nasopharyngeal carcinoma? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:104. [PMID: 31019954 DOI: 10.21037/atm.2019.02.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Which induction chemotherapy (IC) regimen followed by cisplatin-based concurrent chemoradiotherapy (CCRT) is the best choice among PF (cisplatin and 5-fluorouracil), TP (docetaxel and cisplatin) and TPF (docetaxel, cisplatin, and 5-fluorouracil) remains controversial in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). This Bayesian network meta-analysis investigated the efficacy and toxicity of these three common IC regimens and attempted to find the optimal chemotherapy regimen. Methods We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) up to December, 2017. Then, we screened studies for eligibility, extracted data, assessed their quality, tested consistency, and used Bayesian network meta-analysis to combine direct and indirect evidence. Results Ten records were identified involving 7 eligible RCTs with 1,570 patients. Results of the Bayesian network meta-analysis shows that TPF [hazard ratios (HRs) 0.68; 95% credibility interval (CrI), 0.42-1.1], TP (HRs 0.70; 95% CrI, 0.22-2.2) and PF (HRs 1.0; 95% CrI, 0.71-1.5) have the probability of 49.61%, 47.45% and 1.57% respectively to be the optimal induction regimen. Docetaxel-based regimens, including TP [risk ratios (RRs) 5.9; 95% CrI, 1.4-26.0) and TPF (RRs 4.5; 95% CrI, 1.1-18.0), significantly increase the incidence of hematological toxicity. As for ≥ grade 3 mucositis, 5-fluorouracil-based regimens, including PF (RRs 2.1; 95% CrI, 0.91-5.8) and TPF (RRs 1.4; 95% CrI, 0.48-4. 6), are higher than TP (RRs 1.1; 95% CrI, 0.30-4.6). Conclusions Only considering overall survival (OS), TPF has the highest probability to be the optimal choice in LA-NPC and TP also shows encouraging anti-tumor effects. However, we also noticed that TPF induced worse adverse events, especially in ≥ grade 3 hematological toxicity and oral mucositis.
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Affiliation(s)
- Yan He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Guo
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yu Sun
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hui Guan
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shaoyong Wu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
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