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Zhu F, Wu Y, Wang H. Advance in integrating platinum-based chemotherapy with radiotherapy for locally advanced nasopharyngeal carcinoma. Front Oncol 2023; 13:1259331. [PMID: 37860184 PMCID: PMC10583715 DOI: 10.3389/fonc.2023.1259331] [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: 07/15/2023] [Accepted: 09/12/2023] [Indexed: 10/21/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant tumor characterized by the malignant transformation of nasopharyngeal epithelial cells. It is highly sensitive to radiation therapy, making radiotherapy the primary treatment modality. However, 60-80% of patients are initially diagnosed with locally advanced NPC (LA-NPC), where radiotherapy alone often fails to achieve desirable outcomes. Therefore, combining radiotherapy with chemotherapy has emerged as an effective strategy to optimize treatment for LA-NPC patients. Among the various chemotherapy regimens, concurrent chemoradiotherapy (CCRT) using platinum-based drugs has been established as the most commonly utilized approach for LA-NPC patients. The extensive utilization of platinum drugs in clinical settings underscores their therapeutic potential and emphasizes ongoing efforts in the development of novel platinum-based complexes for anticancer therapy. The aim of this review is to elucidate the remarkable advances made in the field of platinum-based therapies for nasopharyngeal carcinoma, emphasizing their transformative impact on patient prognosis.
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Affiliation(s)
- Fubin Zhu
- Department of Cancer Center, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, China
| | - Yidan Wu
- Center for Geriatric Medicine Assessment and Treatment, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Hua Wang
- Department of General Surgery, Chengdu Public Health Clinical Medical Center, Sichuan, Chengdu, China
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Fang Y, Fan J, Yan C. Treatment Protocols in the Efficacy and Safety of Anti-EGFR Medicines in Combination with Standard Therapy for Patients with Nasopharyngeal Cancer: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9477442. [PMID: 36794258 PMCID: PMC9925253 DOI: 10.1155/2023/9477442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 02/08/2023]
Abstract
Objective This study was conducted to compare the efficacy of standard therapy (radiotherapy/RT/CT) with that of antiepidermal growth factor receptor (anti-EGFR) monoclonal antibody (NPC) therapy in patients with advanced nasopharyngeal cancer. Methods A meta-analysis was performed to meet the objective of this study. The English databases PubMed, Cochrane Library, and Web of Science were searched. The literature review compared anti-EGFR-targeted therapy with conventional therapy practices. The main outcome measure was overall survival (OS). Secondary goals were progression-free survival (PFS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and adverse events (grade 3). Results The database search resulted in 11 studies, with a total of 4219 participants. It was found that combining an anti-EGFR regimen with conventional therapy did not enhance OS (hazard ratio [HR] = 1.18; 95%confidence interval [CI] = 0.51-2.40; p = 0.70) or PFS appreciably (HR = 0.95; 95%CI = 0.51-1.48; p = 0.88) in patients with nasopharyngeal carcinoma. While LRRFS increased considerably (HR = 0.70; 95%CI = 0.67-1.00; p = 0.01), the combined regimen did not improve DMFS (HR = 0.86; 95%CI = 0.61-1.12; p = 0.36). Treatment-related adverse events included haematological toxicity (RR = 0.2; 95%CI = 0.08-0.45; p = 0.01), cutaneous reactions (RR = 7.05; 95%CI = 2.15-23.09; p = 0.01), and mucositis (RR = 1.96; 95%CI = 1.58-2.09; p = 0.01). Conclusions Individuals who have nasopharyngeal cancer do not have an increased chance of surviving until a local recurrence of their disease if they get normal therapy in addition to an anti-EGFR regimen. However, this combination does not enhance overall survival. On the other hand, this factor adds to an increase in the number of adverse effects.
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Affiliation(s)
- Yakun Fang
- Obstetrics Department, Qingdao Municipal Hospital, Qingdao 266071, China
| | - Jinlei Fan
- Obstetrics Department, Qingdao Municipal Hospital, Qingdao 266071, China
| | - Chao Yan
- Department of Radiation Oncology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 266035, China
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Cai Z, Chen D, Qiu W, Liang C, Huang Y, Zhou J, Zhan Z, Xiang Y, Guo X, Lv X. Concurrent chemoradiotherapy combined with nimotuzumab in stage III–IVa nasopharyngeal carcinoma: a retrospective analysis. J Cancer Res Clin Oncol 2022; 149:2327-2344. [PMID: 36289067 DOI: 10.1007/s00432-022-04355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The efficacy and safety of nimotuzumab (NTZ) added to concurrent chemoradiotherapy (CCRT) were investigated in patients with stage III-IVa nasopharyngeal carcinoma (NPC). METHODS Patients with stage III-IVa NPC treated with CCRT, with or without NTZ, were screened between January 2015 and December 2017. We compared patients' overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) between different therapeutic regimens. Propensity score matching (PSM) was applied to reduce the selection bias. Nomogram models were developed to predict the survival of CCRT with or without NTZ. RESULTS Four hundred and twenty-six patients were included after PSM, with 213 patients in each regimen. Compared with NPC patients receiving CCRT alone, patients who received NTZ plus CCRT treatment had significantly better OS (5 year OS, 76.1 vs. 72.3%, P = 0.004), PFS (5 year PFS, 73.2 vs. 69.0%, P = 0.002), and LRFS (5 year LRFS, 73.2 vs. 69.0%, P = 0.028). A multivariate Cox regression analysis demonstrated that, compared with receiving CCRT alone, NTZ plus CCRT was an independently positive factor for OS, PFS, and LRFS. No significant difference was observed in the major toxicities between the two treatments (all P > 0.05). In addition, the nomogram presented good accuracy for predicting the prognosis of NPC patients. CONCLUSION CCRT combined with NTZ presented favorable clinical outcomes for stage III-IVa NPC patients with good tolerance and similar toxicity compared to CCRT alone. A prospective, randomized clinical trial is essential to validate the current findings.
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Affiliation(s)
- Zhuochen Cai
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Dongni Chen
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510089, Guangdong, People's Republic of China
| | - Wenze Qiu
- Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, No 78, Hengzhigang Road, Yuexiu District, Guangzhou, 510095, Guangdong, People's Republic of China
| | - Chixiong Liang
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yingying Huang
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jiayu Zhou
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zejiang Zhan
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yanqun Xiang
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xiang Guo
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Xing Lv
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People's Republic of China.
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Lien CF, Wang CC, Yang CC, Wang CC, Hwang TZ, Shih YC, Yeh SA, Hsieh MC. Platinum Plus Tegafur-Uracil versus Platinum Alone during Concurrent Chemoradiotherapy in Patients with Nonmetastatic Nasopharyngeal Carcinoma: A Propensity-Score-Matching Analysis. Cancers (Basel) 2022; 14:cancers14184511. [PMID: 36139674 PMCID: PMC9496885 DOI: 10.3390/cancers14184511] [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: 08/29/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Concurrent chemoradiotherapy (CCRT) with a cisplatin-based regimen is the standard treatment for patients with nasopharyngeal carcinoma (NPC). Our study was a propensity-score-matching analysis and it aimed to investigate the oncologic outcomes of platinum plus tegafur−uracil versus platinum alone during CCRT in patient with nonmetastatic NPC. Patients with pathologic confirmed NPC in 2018−2022 were reviewed. Patients treated with platinum plus tegafur−uracil (CCRT-UP) or platinum alone (CCRT-P) during CCRT were recruited into this study. A propensity-score-matching analysis was conducted to diminish the selection bias. The recurrence-free survival (RFS) and overall survival (OS) were presented with Kaplan−Meier curves. The treatment-related adverse effects (AEs) were recorded according to the National Cancer Institute’s Common Terminology Criteria V3.0. A total of 44 patients with CCRT-UP and 44 patients with CCRT-P were identified after propensity score matching. The median RFS was not reached (NR) in the CCRT-UP group, and it was 12.5 months in the CCRT-P group (p < 0.001). The median OS was NR in the CCRT-UP group, and it was 15.9 months in the CCRT-P group (p < 0.001). The overall response rate and disease-control rate were insignificant between the CCRT-UP and CCRT-P groups. A subgroup analysis showed that the median OS was significantly longer in the CCRT-UP group than in the CCRT-P group, regardless of the clinical stage. A multivariate analysis exhibited that CCRT-UP was independently correlated with survival. The grade 3−4 AEs were insignificant between the CCRT-UP and CCRT-P arms. CCRT-UP had better RFS and OS in nonmetastatic NPC patients with similar toxic profiles. Further larger-scaled prospective randomized control trials are warranted to validate our conclusions.
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Affiliation(s)
- Ching-Feng Lien
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 824005, Taiwan
- College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan
| | - Chien-Chung Wang
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 824005, Taiwan
- College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan
| | - Chuan-Chien Yang
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 824005, Taiwan
- College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan
| | - Chih-Chun Wang
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 824005, Taiwan
- College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan
| | - Tzer-Zen Hwang
- Department of Otolaryngology, E-Da Hospital, Kaohsiung 824005, Taiwan
- College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan
| | - Yu-Chen Shih
- College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan
- Department of Otolaryngology, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
| | - Shyh-An Yeh
- College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan
- Department of Radiation Oncology, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Meng-Che Hsieh
- College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
- Correspondence:
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Hasannia M, Abnous K, Taghdisi SM, Nekooei S, Ramezani M, Alibolandi M. Synthesis of doxorubicin-loaded peptosomes hybridized with gold nanorod for targeted drug delivery and CT imaging of metastatic breast cancer. J Nanobiotechnology 2022; 20:391. [PMID: 36045404 PMCID: PMC9429417 DOI: 10.1186/s12951-022-01607-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer nanomedicines based on synthetic polypeptides have attracted much attention due to their superior biocompatibility and biodegradability, stimuli responsive capability through secondary conformation change, adjustable functionalities for various cargos such as peptides, proteins, nucleic acids and small therapeutic molecules. Recently, a few nanoformulations based on polypeptides comprising NK105, NC6004, NK911, CT2103, have entered phase I-III clinical trials for advanced solid tumors therapy. In the current study, we prepared polypeptide-based vesicles called peptosome via self-assembly of amphiphilic polypeptide-based PEG-PBLG diblock copolymer. RESULTS In this regard, poly(γ-benzyl L-glutamate (PBLG) was synthesized via ring opening polymerization (ROP) of γ-benzyl L-glutamate-N-carboxyanhydride (BLG-NCA) using N-hexylamine as initiator. Then amine-terminated PBLG was covalently conjugated to heterofuctional maleimide PEG-carboxylic acid or methyl-PEG-carboxylic acid. The PEG-PBLG peptosomes were prepared through double emulsion method for the co-delivery of doxorubicin.HCl and gold nanorods as hydrophilic and hydrophobic agents in interior compartment and membrane of peptosomes, respectively (Pep@MUA.GNR-DOX) that DOX encapsulation efficiency and loading capacity were determined 42 ± 3.6 and 1.68 ± 3.6. Then, theranostic peptosomes were decorated with thiol-functionalized EpCAM aptamer throught thiol-maleimide reaction producing Apt-Pep@MUA.GNR-DOX for targeted delivery. The non-targeted and targeted peptosomes showed 165.5 ± 1.1 and 185 ± 4.7 nm diameters, respectively while providing sustained, controlled release of DOX. Furthermore, non-targeted and targeted peptosomes showed considerable serum stability. In vitro study on MCF-7 and 4T1 cells showed significantly higher cytotoxicity for Apt-Pep@MUA.GNR-DOX in comparison with Pep@MUA.GNR-DOX while both system did not show any difference in cytotoxicity against CHO cell line. Furthermore, Apt-Pep@MUA.GNR-DOX illustrated higher cellular uptake toward EpCAM-overexpressing 4T1 cells compared to Pep@MUA.GNR-DOX. In preclinical stage, therapeutic and diagnostic capability of the prepared Pep@MUA.GNR-DOX and Apt-Pep@MUA.GNR-DOX were investigated implementing subcutaneous 4T1 tumor model in BALB/c mice. The obtained data indicated highest therapeutic index for Apt-Pep@MUA.GNR-DOX compared to Pep@MUA.GNR-DOX and free DOX. Moreover, the prepared system showed capability of CT imaging of tumor tissue in 4T1 tumorized mice through tumor accumulation even 24 h post-administration. CONCLUSION In this regard, the synthesized theranostic peptosomes offer innovative hybrid multipurpose platform for fighting against breast cancer.
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Affiliation(s)
- Maliheh Hasannia
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khalil Abnous
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mohammad Taghdisi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sirous Nekooei
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Ramezani
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. .,Pharmaceutical Technology Institute, Nanotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mona Alibolandi
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Li Z, Zhao Y. Influence of CDK5 Regulatory Subunit-Associated Protein 1-Like 1 Expression on the Survival of Patients with Non-Metastatic Nasopharyngeal Carcinoma. Cancer Manag Res 2021; 13:4821-4828. [PMID: 34168501 PMCID: PMC8216668 DOI: 10.2147/cmar.s314925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to investigate the influence of CDK5 regulatory subunit-associated protein 1-like 1 (CDKAL1) expression on the survival of nasopharyngeal carcinoma (NPC) patients. Methods A total of 140 non-metastatic NPC patients were retrospectively analyzed. The expression of CDKAL1 was detected by immunohistochemistry. Results The CDKAL1-negative group exhibited better overall survival (OS) according to Kaplan–Meier curve analysis (p = 0.006), with 5-year OS rates for the CDKAL1-negative and -positive groups of 89.7% and 70.2%, respectively. The CDKAL1-negative group also exhibited a tendency toward a better progression-free survival (PFS) rate. Multivariate analysis showed that CDKAL1 expression was independently associated with both OS (p = 0.002) and PFS (p = 0.043). Conclusion CDKAL1 expression is an independent negative predictor of patient survival in non-metastatic NPC.
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Affiliation(s)
- Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, People's Republic of China
| | - Yajie Zhao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, People's Republic of China
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Liang R, Yang L, Zhu X. Nimotuzumab, an Anti-EGFR Monoclonal Antibody, in the Treatment of Nasopharyngeal Carcinoma. Cancer Control 2021; 28:1073274821989301. [PMID: 33504193 PMCID: PMC8482709 DOI: 10.1177/1073274821989301] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) is highly expressed in most of Nasopharyngeal carcinoma (NPC) samples and is associated with poor outcomes. Therefore, targeting EGFR may be a promising strategy to improve patient prognosis. Nimotuzumab is a humanized anti-EGFR monoclonal antibody. Recently, accumulating evidence has demonstrated that combination nimotuzumab and induction chemotherapy, radiotherapy, or concurrent chemoradiotherapy confer benefits for patients with NPC. Moreover, the side effects of such regimes are tolerable. In this review, we focus on the current data of nimotuzumab in clinical trials in the treatment of NPC.
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Affiliation(s)
- Renba Liang
- Department of Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China.,Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.,Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
| | - Liu Yang
- Department of Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Xiaodong Zhu
- Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.,Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China.,Key Laboratory of Early Prevention and Treatment for Regional High-Incidence-Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, People's Republic of China
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Song X, Wang S, Li J, Yan L, Chen F, Wang J. Induction chemotherapy plus nimotuzumab followed by concurrent chemoradiotherapy for advanced nasopharyngeal carcinoma. Arch Med Sci 2021; 17:1317-1324. [PMID: 34522261 PMCID: PMC8425246 DOI: 10.5114/aoms.2019.86712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This study investigated the best mode for the application of nimotuzumab (Nimo) in combination with chemoradiotherapy to treat nasopharyngeal carcinoma (NPC). MATERIAL AND METHODS Data were prospectively collected from 168 patients with NPC from September 2009 to February 2014. One hundred twelve patients received 2-3 cycles of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT), and 56 patients with well-matched propensity scores received IC + CCRT + Nimo. Patients were divided into 3 subgroups according to the application schedule of Nimo: group A, IC + CCRT; group B: IC (combined with Nimo) + CCRT; and group C: IC + CCRT (combined with Nimo). The 5-year overall survival (OS) and progression-free survival (PFS) and adverse events were investigated. RESULTS With a median follow-up of 61.4 months (range: 1.7-96.5 months), the 5-year OS and PFS for group A vs. groups B + C were 74.8 ±4.1% versus 87.0 ±4.6% (p = 0.043) and 72.7 ±4.3% vs. 83.1 ± 5.1% (p = 0.243), respectively. The 5-year OS of group B was significantly improved over that of group A (93.0 ±4.8% vs. 74.8 ±4.1%, p = 0.038); however, there was no benefit to the 5-year PFS (89.3 ±5.9% vs. 72.7 ±4.3%, p = 0.144). The 5-year OS and PFS for group C were 80.4 ±7.9% and 76.4 ±8.5%, respectively, and there was no statistically significant difference from group A (p = 0.257 and p = 0.611, respectively). No significant increase in toxicities was observed with the addition of Nimo. CONCLUSIONS Nimo administered with chemoradiotherapy is effective for NPC. Nimo concurrent with IC followed by CCRT could be the optimal mode of sequential treatment.
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Affiliation(s)
- Xinmao Song
- Department of Radiation Oncology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Ji Li
- Department of Radiation Oncology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Li Yan
- Department of Radiation Oncology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Fu Chen
- Department of Radiation Oncology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Jie Wang
- Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
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Chen X, Liang R, Zhu X. Anti-EGFR therapies in nasopharyngeal carcinoma. Biomed Pharmacother 2020; 131:110649. [PMID: 32836074 DOI: 10.1016/j.biopha.2020.110649] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 01/18/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a common malignant tumor in Southern China and South-East Asia. Regardless of initiative high response to radiotherapy, parts of patients still have relapses and metastases. It is reported that epidermal growth factor receptor (EGFR) is highly expressed in most of NPC and is a poor prognostic factor. Targeting EGFR therapies including monoclonal antibodies and EGFR tyrosine kinase inhibitors (EGFR-TKIs), offer different benefits and toxicities for patients with NPC. Herein, we summarize the clinical evidence of anti-EGFR therapies in the management of NPC and provide a direction for the treatment and research of NPC in the future.
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Affiliation(s)
- Xishan Chen
- Department of Oncology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, 545000, China; Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, PR China
| | - Renba Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, PR China
| | - Xiaodong Zhu
- Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, PR China; Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, PR China; Key Laboratory of Early Prevention and Treatment for Regional High-Incidence-Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, PR China.
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Thai Hoa NT, Quang Huy H. Combined Nimotuzumab with Chemoradiotherapy for Locally Advanced Head and Neck Squamous Cell Carcinoma. Cureus 2020; 12:e8105. [PMID: 32426197 PMCID: PMC7228796 DOI: 10.7759/cureus.8105] [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: 11/19/2022] Open
Abstract
Background Most head and neck cancers (HNCs), specifically squamous cell carcinoma, express epidermal growth factor and are associated with an inadequate response to radiotherapy and chemotherapy. Anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (mAb) increase response rates and survival when combined with radiotherapy or chemoradiotherapy (CRT). This study evaluates the outcome and toxicity of the nimotuzumab-CRT combination for stage III, IVa, and IVb squamous cell carcinoma of the head and neck. Methods Eighty-seven patients with squamous cell carcinoma of the head and neck, stage III, IVa, or IVb were enrolled in a prospective comparative study. The nimotuzumab plus CRT group consisted of patients who received nimotuzumab 200 mg every week for six consecutive weeks chemoradiation therapy; cisplatin 30 mg/m2 every week for six weeks; radiotherapy of 2-Gy/fraction, five fractions/week for a total dose of 70 Gy; and neck lymph node invasion prophylaxis at 50 Gy. The CRT alone arm was treated with CRT (without nimotuzumab). Results Tumor response rate of 90.6% was achieved in nimotuzumab plus CRT group (complete response: 58.1%), and 70.4% in CRT alone arm (complete response: 38.6%; p=0.029). The lymph node response rate was 83.4% in nimotuzumab plus CRT group (complete response: 46.7%), and 73.0% in CRT group (complete response: 23.0%). The general response rate in nimotuzumab plus CRT group was 86.0% (complete response: 48.8%), and 68.0% in CRT alone arm (complete response: 36.0%). Twelve-month overall survival (OS) was 75.1% for the nimotuzumab plus CRT group and 54.4% for the CRT group. The 24-month survival was 48.0% (nimotuzumab plus CRT group) and 29.0% (CRT alone arm). The median OS was 20 months and 13 months for nimotuzumab plus CRT group and CRT alone arm, respectively. Progression-free survival (PFS) in the nimotuzumab plus CRT group at 12 months and 24 months was 64.2% and 37.4%, respectively. PFS in the CRT group at 12 months and 24 months was 39.5% and 21.3%, respectively. Infusion reaction presented mildly in two of 43 patients in the nimotuzumab plus CRT group, and no shock occurred. Other toxicity occurrences were similar between the two groups, mainly in grade I, II. Skin rash (grade I only) occurred at a rate of 4.7% in the nimotuzumab plus CRT group. Conclusion Nimotuzumab in combination with CRT was well tolerated as a treatment program for locally advanced head and neck squamous cell carcinoma.
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Affiliation(s)
- Nguyen Thi Thai Hoa
- Department of Internal Medicine, Vietnam National Cancer Hospital, Hanoi, VNM
| | - Huynh Quang Huy
- Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, VNM
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11
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Zhi-Qiang W, Qi M, Ji-Bin L, Rui Y, You-Ping L, Rui S, Guang-Yuan H, Ming-Yuan C, Yi-Jun H. The long-term survival of patients with III-IVb stage nasopharyngeal carcinoma treated with IMRT with or without Nimotuzumab: a propensity score-matched analysis. BMC Cancer 2019; 19:1122. [PMID: 31744469 PMCID: PMC6862826 DOI: 10.1186/s12885-019-6156-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background To assess the efficacy of Nimotuzumab in combination with first-line chemoradiotherapy treatment in Chinese patients with primary III-IVb stage nasopharyngeal carcinoma. Methods Patients with primary locoregionally advanced nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy (IMRT) and concurrent cisplatin-based chemotherapy between January 2008 and December 2013 at a single institution were retrospectively reviewed. Group A received at least 6 doses of Nimotuzumab, while Group B did not receive Nimotuzumab. A propensity score matching method was used to match patients from each group in a 1:3 ratio. Results In total, 730 eligible patients were propensity matched, with 184 patients in Group A and 546 patients in Group B. Significant differences were not observed in the patient and tumor characteristics between Group A and Group B. At a median follow-up of 74.78 months (range 3.53–117.83 months), locoregional recurrence, distant failure and death were observed in 10.68, 11.10 and 16.03% of all patients, respectively. The estimated 5-year locoregional relapse–free survival, distant metastasis–free survival, progression-free survival and overall survival in the Group A versus Group B were 85.34% versus 89.79% (P = 0.156), 93.09% versus 85.61% (P = 0.012), 79.96% versus 77.99% (P = 0.117) and 88.91% versus 78.30% (P = 0.006), respectively. Conclusions This nimotuzumab-containing regimen resulted in improved long-term survival of III-IVb stage NPC patients and warrants further prospective evaluation.
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Affiliation(s)
- Wang Zhi-Qiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Mei Qi
- Department of Oncology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Techology, Wuhan, China
| | - Li Ji-Bin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - You Rui
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Liu You-Ping
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Sun Rui
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Hu Guang-Yuan
- Department of Oncology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Techology, Wuhan, China
| | - Chen Ming-Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
| | - Hua Yi-Jun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
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12
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Mao L, Tan J, Wang F, Luo Y, Liu W, Zeng F, Yu B, Huang H, Lu J, Peng X, Liu X. Retrospective study comparing anti-EGFR monoclonal antibody plus cisplatin-based chemoradiotherapy versus chemoradiotherapy alone for stage II-IVb nasopharyngeal carcinoma and prognostic value of EGFR and VEGF expression. Clin Otolaryngol 2019; 44:572-580. [PMID: 30972891 DOI: 10.1111/coa.13340] [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: 06/14/2018] [Revised: 12/18/2018] [Accepted: 04/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The benefits of adding anti-EGFR therapy to conventional chemoradiotherapy (CRT) for nasopharyngeal carcinoma (NPC) remain uncertain, possibly because only a subgroup of patients show better outcome. To address this issue, we compared the efficacy of CRT plus cetuximab (CTX) or nimotuzumab (NTZ) to CRT alone for stage II-IVb NPC and examined possible prognostic indicators, including tumour EGFR and VEGR expression levels. DESIGN, SETTING AND PARTICIPANTS This retrospective study enrolled 1812 patients at initial NPC diagnosis at Nanfang Hospital Affiliated to Southern Medical University between January 2005 and December 2015. The cetuximab or nimotuzumab plus CRT group (CRT+NTZ/CTX) and the conventional chemoradiotherapy group (CRT) were matched by propensity scoring at 1:5, yielding 282 patients at clinical stage II-IVb with 47 in the CRT+NTZ/CTX group and 235 in the CRT group. MAIN OUTCOME MEASURES The endpoints of the present study were locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS). Immunohistochemistry (IHC) was used to investigate EGFR and VEGF expression levels in 31 patients of the CRT+NTZ/CTX group. RESULTS There were no significant differences in LRFS, DMFS and OS, haematologic toxicity reactions, and gastrointestinal reactions between CRT+NTZ/CTX and CRT groups. There was a positive correlation between EGFR and VEGF expression levels. Among CRT+NTZ/CTX patients, those with high EGFR and VEGF expression levels exhibited better DMFS. CONCLUSIONS Addition of anti-EGFR to cisplatin-based CRT appears to benefit only a subset of stage II-IVb NPC patients, those with elevated EGFR and VEGF expression levels.
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Affiliation(s)
- Linwei Mao
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Otolaryngology, Affiliated Putian Hospital, Southern Medical University (Affiliated Hospital of Putian College), Putian, China
| | - Jiajie Tan
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Wang
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunfan Luo
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Liu
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fangfang Zeng
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bolong Yu
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haoran Huang
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Juan Lu
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaohong Peng
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiong Liu
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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13
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Peng L, Liu ZL, Xu C, Tang LL, Liu X, Lin AH, Sun Y, Chen YP, Ma J. The Efficacy and Safety of Anti-epidermal Growth Factor Receptor Monoclonal Antibodies in Nasopharyngeal Carcinoma: Literature-based Meta-analyses. J Cancer 2018; 9:4510-4520. [PMID: 30519357 PMCID: PMC6277641 DOI: 10.7150/jca.27611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 09/10/2018] [Indexed: 12/23/2022] Open
Abstract
Background: Anti-epidermal growth factor receptor monoclonal antibodies (anti-EGFR mAbs), such as cetuximab and nimotuzumab have been used in the treatment of nasopharyngeal carcinoma (NPC), yet their efficacy and safety are undetermined. Materials and Methods: We performed two meta-analyses based on systematic searches of PubMed, EMBASE, the Cochrane Library and SinoMed: comparison 1 (standard therapy plus mAbs vs. standard therapy) and comparison 2 (radiotherapy plus concurrent mAbs vs. concurrent chemoradiotherapy) to explore the treatment value of anti-EGFR mAbs in NPC. Primary outcomes were overall survival (OS) and disease-free survival (DFS); secondary outcomes, locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and grade 3 and above acute adverse events. Results: Four randomized controlled trials and thirteen observational studies were eligible. Comparison 1 (twelve studies): adding mAbs to standard therapy (radiotherapy or chemoradiotherapy) significantly improved OS (HR, 0.51; 95% CI, 0.39-0.66) and DFS (HR, 0.68; 95% CI, 0.54-0.86), but increased the frequency of skin rashes and mucositis. Comparison 2 (six studies): OS (HR, 1.17; 95% CI, 0.81-1.70) and DFS (HR, 1.16; 95% CI, 0.86-1.57) were not significantly different when mAbs replaced conventional cytotoxic chemotherapy concurrently with radiotherapy, with fewer hematological, gastrointestinal and renal toxicities and more skin rashes in the mAb group. Conclusion: We recommend anti-EGFR mAbs enhance-but should not replace-current treatment paradigms for locoregionally advanced NPC. Further evidence from phase III clinical trials is required.
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Affiliation(s)
- Liang Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre; State Key Laboratory of Oncology in South China; Collaborative Innovation Centre of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ze-Long Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Centre; State Key Laboratory of Oncology in South China; Collaborative Innovation Centre of Cancer Medicine, Guangzhou, China
| | - Cheng Xu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre; State Key Laboratory of Oncology in South China; Collaborative Innovation Centre of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre; State Key Laboratory of Oncology in South China; Collaborative Innovation Centre of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xu Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre; State Key Laboratory of Oncology in South China; Collaborative Innovation Centre of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre; State Key Laboratory of Oncology in South China; Collaborative Innovation Centre of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yu-Pei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre; State Key Laboratory of Oncology in South China; Collaborative Innovation Centre of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre; State Key Laboratory of Oncology in South China; Collaborative Innovation Centre of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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14
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Zhang S, huang X, Zhou L, Lin S. Efficacy of concurrent chemoradiotherapy combined with nimotuzumab for low-risk T4 stage nasopharyngeal carcinoma: A pilot study. Medicine (Baltimore) 2018; 97:e12503. [PMID: 30235761 PMCID: PMC6160225 DOI: 10.1097/md.0000000000012503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the efficacy and safety of concurrent chemoradiotherapy combined with Nimotuzumab for low-risk T4 stage nasopharyngeal carcinoma (NPC). METHODS This study included 49 low-risk T4 stage NPC patients treated with concurrent chemoradiotherapy plus Nimotuzumab. The IMRT doses were planning target volume (PTV) 70-72 Gy for gross disease in the nasopharynx, and 66-70 Gy for positive lymph nodes. The doses for high risk and low risk region PTV were 60-62 Gy and 54-56 Gy in 31-33 fractions. All patients received a chemotherapy program consisting of Cisplatin 100mg/m2, day 1, Q3w and were treated by Nimotuzumab (Nimotuzumab 200mg, iv, Qw). RESULTS All 49 patients completed at least two cycles of chemotherapy and seven weeks of Nimotuzumab. The total efficiency of therapy was 100.0%. The 3-year overall survival (OS), distant metastasis-free survival (DMFS), local-regional control (LRC) and progression-free survival (PFS) rates were 89.7%, 87.8%, 97.9% and 85.7%, respectively. No regional lymph node recurrence was detected. The most serious acute toxicity was mucositis, with prevalence of Grades 0 to IV being 0.0%, 57.1%, 34.7%, 8.2%, and 0.0%, respectively. Late toxicity manifested as Grades I and II xerostomia in 32 and 10 patients. CONCLUSION In patients with low-risk T4 stage NPC, concurrent chemoradiotherapy combined with Nimotuzumab yielded an excellent local control rate, and the toxicities were mild and tolerable. Distant metastasis was the main cause of treatment failure.
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15
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Liang ZG, Lin GX, Ye JX, Li Y, Li L, Qu S, Liang X, Zhu XD. Cetuximab or Nimotuzumab Versus Cisplatin Concurrent with Radiotherapy for Local-Regionally Advanced Nasopharyngeal Carcinoma: a Meta-analysis. Asian Pac J Cancer Prev 2018; 19:1397-1404. [PMID: 29802706 PMCID: PMC6031838 DOI: 10.22034/apjcp.2018.19.5.1397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: It is unclear whether Cetuximab (CTX) or Nimotuzumab (NTZ) concurrent with radiotherapy delivers
equivalent or improved results with fewer toxicities over standard cisplatin (CDDP) concurrent with radiotherapy
in locally advanced nasopharyngeal carcinoma (NPC). Methods: The strategy involved searching the PubMed,
Embase, Cochrane Library, China National Knowledge Internet Web, Wanfang and Chinese Biomedical databases.
Controlled clinical trials that compared concurrent CTX/NTZ with radiotherapy versus CDDP with radiotherapy
in local-regionally advanced NPC were included. Results: In all, 1,239 patients in six clinical trials were included
in the analysis. The hazard ratios (HRs) between the CTX/NTZ and CDDP groups were 1.01 (95% confidence interval
(CI) 0.63-1.64), 1.06 (95% CI 0.50-2.25), 1.04 (95% CI 0.61-1.76), and 1.05 (95% CI 0.73-1.50) for overall survival,
local-regional failure-free survival, distant metastasis failure-free survival, and disease-free survival, respectively.
Significant differences were found in the incidences of grade 3-4 anaemia [Risk ratio (RR) 0.11 95% CI 0.02-0.58], grade
3-4 neutropenia (RR 0.23 95% CI 0.12- 0.44), grade 3-4 thrombocytopenia (RR 0.31 95% CI 0.12- 0.79), and grade
3-4 vomiting (RR 0.04 95% CI 0.00-0.29) in favour of the CTX/NTZ group. However, the patients in the CTX/NTZ
group experienced a higher incidence of grade 3-4 skin rash (RR 6.45 95% CI 3.84-10.84). Conclusions: Regarding
the efficacy and side effects, the combination of CTX / NTZ and radiotherapy may be an alterative treatment regimen
of standard CDDP concurrent with radiotherapy in local-regionally advanced NPC, especially in patients who cannot
tolerate or who refuse chemotherapy.
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Affiliation(s)
- Zhong Guo Liang
- Department of Radiation Oncology, The Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, 71 He Di Road, Nanning 530021, P.R. China
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16
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Wang F, Sun Q, Jiang C, Liu T, Rihito A, Masoto S, Wang Y, Fu Z, Chen M. Additional induction chemotherapy to concurrent chemotherapy and intensity-modulated radiotherapy with or without nimotuzumab in first-line treatment for locoregionally advanced nasopharyngeal carcinoma: a propensity score matched analysis. J Cancer 2018; 9:594-603. [PMID: 29483965 PMCID: PMC5820927 DOI: 10.7150/jca.20461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/31/2017] [Indexed: 12/15/2022] Open
Abstract
Background: The aim of this study is to assess the survival benefits of additional induction chemotherapy before concurrent chemotherapy, intensity-modulated radiotherapy and nimotuzumab in patients with locoregionally advanced nasopharyngeal carcinoma. Methods: Clinical data from 1104 nonmetastatic nasopharyngeal carcinoma patients diagnosed between May 2008 and April 2014 were retrospectively reviewed. All patients received addition of induction chemotherapy to concurrent chemoradiotherapy with or without nimotuzumab. A propensity score matched method was used to identify paired patients according to various covariates. Results: In total, 120 pairs were selected by propensity score matched method. At a median follow-up time of 56 months (10-99 months), the 5-year locoregional relapse-free survival, distant metastases-free survival, progression-free survival and overall survival rates in patients treated with nimotuzumab vs. without nimotuzumab were 91.6% vs. 91.1% (P= 0.957), 95.8% vs. 83.9% (P= 0.007), 87.4% vs. 81.3% (P= 0.225), 94.5% vs. 85.6% (P= 0.058), respectively. Multivariate analysis revealed that nimotuzumab was an independent prognosticator of OS and DMFS. Conclusions: Nimotuzumab is an effective treatment option for locoregionally advanced nasopharyngeal carcinoma, and the addition of induction chemotherapy to concurrent chemoradiotherapy and nimotuzumab could obtain the best survival benefits.
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Affiliation(s)
- Fangzheng Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
- Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501 Japan
| | - Quanquan Sun
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
- Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Chuner Jiang
- Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Tongxin Liu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
- Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Aizawa Rihito
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University. Kyoto, 606-8507 Japan
| | - Sakamoto Masoto
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, 918-8501 Japan
| | - Yuezhen Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
- Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Zhenfu Fu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
- Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022, People's Republic of China
- Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022, People's Republic of China
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17
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Wang F, Jiang C, Ye Z, Liu T, Sun Q, Yan F, Qin W, Fu Z, Jiang Y. Treatment Outcomes of 257 Patients with Locoregionally Advanced Nasopharyngeal Carcinoma Treated with Nimotuzumab Plus Intensity-Modulated Radiotherapy with or without Chemotherapy: A Single-Institution Experience. Transl Oncol 2017; 11:65-73. [PMID: 29202278 PMCID: PMC5723380 DOI: 10.1016/j.tranon.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES: To report the long-term outcome and toxicity of locoregionally advanced nasopharyngeal carcinoma (LA NPC) treated with nimotuzumab (h-R3) plus intensity-modulated radiotherapy (IMRT) with or without chemotherapy. METHODS: From May 2008 to March 2014, 3022 newly histology-proven, nonmetastatic NPC patients were retrospectively reviewed; among them, 257 patients treated with h-R3 were enrolled in this study. The patients' age range was between 10 and 76 years. The distribution of patients by disease stage was 150 (58.4%) in stage III, 88 (34.2%) in stage IV A, and 19 (7.4%) in stage IV B. All the patients received the treatment of h-R3 plus IMRT, and from them, 239 cases were also treated with cisplatin-based chemotherapy. Acute and late radiation-related toxicities were graded according to the Acute and Late Radiation Morbidity Scoring Criteria of Radiation Therapy Oncology Group. The accumulated survival was calculated according to the Kaplan-Meier method. Log-rank test was used to compare the survival difference. Multivariate analysis was performed using Cox's proportional-hazard model. RESULTS: All 257 patients had completed combined treatment; 231 patients received h-R3 plus IMRT with induction chemotherapy (IC), while 26 patients received only h-R3 plus IMRT. With a median follow-up of 48 months (range, 13-75 months), the estimated 5-year local recurrence-free survival, regional recurrence-free survival, distant metastases-free survival, progression-free survival, and overall survival (OS) rates were 94.3%, 94.8%, 91.9%, 83.4%, and 86.2%, respectively. Univariate analysis showed that age, T stage, clinical stage, and IC were related with OS. Multivariate analysis indicated that T stage and IC were independent prognostic factors for OS. The incidence of grade 3 to 4 acute mucositis and leukocytopenia was 10.9% and 19.8%, respectively, with no cases of skin rash and infusion reaction. Xerostomia was the most common late complication, and the degree of dry mouth in most survivors was mild to moderate at the last follow-up time. CONCLUSION: h-R3 plus IMRT with or without chemotherapy showed promising outcomes in terms of locoregional control and survival without increasing the incidence of radiation-related toxicities for patients.
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Affiliation(s)
- Fangzheng Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022.
| | - Chuner Jiang
- Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022
| | - Zhimin Ye
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022
| | - Tongxin Liu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022
| | - Quanquan Sun
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022
| | - Fengqin Yan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022
| | - Weifeng Qin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022
| | - Zhenfu Fu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang, Hangzhou, 310022; Zhejiang Key Laboratory of Radiation Oncology, Zhejiang, Hangzhou, 310022
| | - Yangming Jiang
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing, 100101, People's Republic of, China.
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Li Z, Li Y, Yan S, Fu J, Zhou Q, Huang X, Shen L. Nimotuzumab combined with concurrent chemoradiotherapy benefits patients with advanced nasopharyngeal carcinoma. Onco Targets Ther 2017; 10:5445-5458. [PMID: 29180878 PMCID: PMC5694200 DOI: 10.2147/ott.s141538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The potential benefits and possible risks associated with combined nimotuzumab and concurrent chemoradiotherapy in patients with advanced nasopharyngeal carcinoma (NPC) have yet to be determined. METHODS The databases PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang were systematically searched through February 2017 for studies comparing combined nimotuzumab and chemoradiotherapy versus chemoradiotherapy alone in the treatment of NPC. Primary outcomes were complete and partial responses, and the secondary outcome was adverse reactions. The random-effect model was used to pool relative risks (RRs) and 95% confidence intervals (CIs). RESULTS Nine randomized control trials and six cohort studies were included in the final analysis (n=1,015 patients). Compared with chemoradiotherapy alone, chemoradiotherapy combined with nimotuzumab was associated with an increased response rate (RR =1.11, 95% CI: 1.01-1.22). Combined treatment further reduced the occurrence rate of erythropenia (RR =0.11, 95% CI: 0.05-0.28) and neutropenia (RR =0.12, 95% CI: 0.05-0.27). The differences in the rates of other complications were not significant. CONCLUSION Nimotuzumab combined with concurrent chemoradiotherapy is more effective in patients with advanced NPC than chemoradiotherapy alone. Patients receiving combination therapy did not have a higher rate of adverse reactions. Nimotuzumab can thus be recommended as an adjunct therapy in patients with advanced NPC.
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Affiliation(s)
- Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Yanyan Li
- Department of Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Shipeng Yan
- Office of Tumor Prevention and Control, Hunan Provincial Tumor Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jun Fu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Qin Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Xinqiong Huang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
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Wang F, Jiang C, Ye Z, Sun Q, Liu T, Xu M, Wu P, Shi K, Long B, Rihito A, Masoto S, Fu Z. Efficacy and safety of nimotuzumab with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma. Oncotarget 2017; 8:75544-75556. [PMID: 29088889 PMCID: PMC5650444 DOI: 10.18632/oncotarget.17357] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/11/2017] [Indexed: 11/25/2022] Open
Abstract
We assessed the efficacy and safety of nimotuzumab plus neoadjuvant chemotherapy followed by concurrent chemoradiotherapy for Chinese patients with locoregionally advanced nasopharyngeal carcinoma. Clinical data from 210 nonmetastatic nasopharyngeal carcinoma patients diagnosed between May 2008 and April 2014 were retrospectively reviewed. All patients were initially treated with nimotuzumab plus neoadjuvant chemotherapy followed by concurrent chemoradiotherapy. Ninety-five patients received cisplatin-based adjuvant chemotherapy. The median follow-up duration was 48 months. Locoregional relapse and distant metastases occurred in 16 patients (16/210, 7.6%) and 18 patients (18/210, 8.6%), respectively. The 5-year local recurrence-free survival, regional recurrence-free survival, distant metastases-free survival, progression-free survival, and overall survival rates were 95.6%, 94.4%, 91.7%, 84.0%, and 88.7%, respectively. Univariate analysis revealed that concurrent chemotherapy regimens and clinical stage correlated with overall survival, and that adjuvant chemotherapy, N stage, clinical stage, and tumor response at the end of treatment were correlated with progression-free survival. In the multivariate analysis, concurrent chemotherapy regimens, clinical stage, and tumor response were important prognosticators. Grade 3/4 leukocytopenia was experienced by 24 patients (11.4%), and 6 patients (2.9%) developed mild liver damage during the period of neoadjuvant chemotherapy. Grade 3/4 acute mucositis was experienced by 13 patients (6.2%), and 12 patients (5.7%) experienced grade 3/4 leukocytopenia during the concurrent chemotherapy. The efficacy of nimotuzumab plus neoadjuvant chemotherapy followed by concurrent chemotherapy in locoregionally advanced nasopharyngeal carcinoma patients was encouraging and the toxicities were tolerable.
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Affiliation(s)
- Fangzheng Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, People's Republic of China
| | - Chuner Jiang
- Department of Breast Tumor Surgery, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China
| | - Zhimin Ye
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, People's Republic of China
| | - Quanquan Sun
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, People's Republic of China
| | - Tongxin Liu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, People's Republic of China
| | - Min Xu
- Department of Physics, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China
| | - Peng Wu
- Department of Pathology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China
| | - Kaiyuan Shi
- Department of Ultrasonography, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of, China
| | - Bin Long
- Department of Nuclear Medicine, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China
| | - Aizawa Rihito
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Sakamoto Masoto
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Zhenfu Fu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, People's Republic of China
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