1
|
Mai HQ, Chen QY, Chen D, Hu C, Yang K, Wen J, Li J, Shi Y, Jin F, Xu R, Pan J, Qu S, Li P, Hu C, Liu YC, Jiang Y, He X, Wang HM, Lim WT, Liao W, He X, Chen X, Wang S, Yuan X, Li Q, Lin X, Jing S, Chen Y, Lu Y, Hsieh CY, Yang MH, Yen CJ, Samol J, Luo X, Wang X, Tang X, Feng H, Yao S, Keegan P, Xu RH. Toripalimab Plus Chemotherapy for Recurrent or Metastatic Nasopharyngeal Carcinoma: The JUPITER-02 Randomized Clinical Trial. JAMA 2023; 330:1961-1970. [PMID: 38015220 PMCID: PMC10685882 DOI: 10.1001/jama.2023.20181] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/18/2023] [Indexed: 11/29/2023]
Abstract
Importance There are currently no therapies approved by the US Food and Drug Administration for nasopharyngeal carcinoma (NPC). Gemcitabine-cisplatin is the current standard of care for the first-line treatment of recurrent or metastatic NPC (RM-NPC). Objective To determine whether toripalimab in combination with gemcitabine-cisplatin will significantly improve progression-free survival and overall survival as first-line treatment for RM-NPC, compared with gemcitabine-cisplatin alone. Design, Setting, and Participants JUPITER-02 is an international, multicenter, randomized, double-blind phase 3 study conducted in NPC-endemic regions, including mainland China, Taiwan, and Singapore. From November 10, 2018, to October 20, 2019, 289 patients with RM-NPC with no prior systemic chemotherapy in the RM setting were enrolled from 35 participating centers. Interventions Patients were randomized (1:1) to receive toripalimab (240 mg [n = 146]) or placebo (n = 143) in combination with gemcitabine-cisplatin for up to 6 cycles, followed by maintenance with toripalimab or placebo until disease progression, intolerable toxicity, or completion of 2 years of treatment. Main Outcome Progression-free survival as assessed by a blinded independent central review. Secondary end points included objective response rate, overall survival, progression-free survival assessed by investigator, duration of response, and safety. Results Among the 289 patients enrolled (median age, 46 [IQR, 38-53 years; 17% female), at the final progression-free survival analysis, toripalimab treatment had a significantly longer progression-free survival than placebo (median, 21.4 vs 8.2 months; HR, 0.52 [95% CI, 0.37-0.73]). With a median survival follow-up of 36.0 months, a significant improvement in overall survival was identified with toripalimab over placebo (hazard ratio [HR], 0.63 [95% CI, 0.45-0.89]; 2-sided P = .008). The median overall survival was not reached in the toripalimab group, while it was 33.7 months in the placebo group. A consistent effect on overall survival, favoring toripalimab, was found in subgroups with high and low PD-L1 (programmed death-ligand 1) expression. The incidence of all adverse events, grade 3 or greater adverse events, and fatal adverse events were similar between the 2 groups. However, adverse events leading to discontinuation of toripalimab or placebo (11.6% vs 4.9%), immune-related adverse events (54.1% vs 21.7%), and grade 3 or greater immune-related adverse events (9.6% vs 1.4%) were more frequent in the toripalimab group. Conclusions and Relevance The addition of toripalimab to chemotherapy as first-line treatment for RM-NPC provided statistically significant and clinically meaningful progression-free survival and overall survival benefits compared with chemotherapy alone, with a manageable safety profile. These findings support the use of toripalimab plus gemcitabine-cisplatin as the new standard of care for this patient population. Trial Registration ClinicalTrials.gov Identifier: NCT03581786.
Collapse
Affiliation(s)
- Hai-Qiang Mai
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou
| | - Qiu-Yan Chen
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou
| | - Dongping Chen
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Chaosu Hu
- Fudan University Cancer Center, Shanghai, China
| | - Kunyu Yang
- Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Jiyu Wen
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jingao Li
- Jiangxi Cancer Hospital, Nanchang, China
| | - Yingrui Shi
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China
| | - Feng Jin
- The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Ruilian Xu
- Shenzhen People’s Hospital, Shenzhen, China
| | - Jianji Pan
- Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Shenhong Qu
- The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ping Li
- West China Hospital of Sichuan University, Chengdu
| | - Chunhong Hu
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yi-Chun Liu
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi Jiang
- Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Xia He
- Jiangsu Cancer Hospital, Nanjing, China
| | | | - Wan-Teck Lim
- National Cancer Centre, Singapore City, Singapore
| | | | - Xiaohui He
- Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | | | - Siyang Wang
- The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Xianglin Yuan
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Li
- Shanghai General Hospital, Shanghai, China
| | - Xiaoyan Lin
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Shanghua Jing
- The Fourth Hospital of Hebei Medical University Hebei Cancer Hospital, Shijiazhuang, China
| | | | - Yin Lu
- Liuzhou Worker’s Hospital, Liuzhou, China
| | | | - Muh-Hwa Yang
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jui Yen
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jens Samol
- Tan Tock Seng Hospital, Singapore City, Singapore
| | | | | | | | - Hui Feng
- Shanghai Junshi Biosciences, Shanghai, China
- TopAlliance Biosciences, Rockville, Maryland
| | - Sheng Yao
- Shanghai Junshi Biosciences, Shanghai, China
- TopAlliance Biosciences, Rockville, Maryland
| | | | - Rui-Hua Xu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou
| |
Collapse
|
2
|
Xiao BJ, Sima XX, Chen G, Gulizeba H, Zhou T, Huang Y. Predictive and prognostic role of early apolipoprotein A-I alteration in recurrent or metastatic nasopharyngeal carcinoma patients treated with anti-PD-1 therapy. Cancer Med 2023; 12:16918-16928. [PMID: 37409613 PMCID: PMC10501269 DOI: 10.1002/cam4.6321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/06/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The primary objective of this study was to evaluate the predictive and prognostic value of serum lipids in recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) patients received anti-PD-1 therapy. MATERIALS AND METHODS Patients treated with anti-PD-1 therapy (monotherapy or combined with chemotherapy) from two clinical trials (CAPTAIN and CAPTAIN-1st study) were included. Serum lipids were measured at baseline and after two cycles of treatment. We examined the impact of both baseline and post-treatment lipid levels on objective response rate (ORR), progression-free survival (PFS), and duration of response (DOR). RESULTS Of 106 patients, 89 patients (84%) were male. The patients' median age was 49 years. An early elevated (after two cycles of treatment) cholesterol (CHO), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A-I (ApoA-I), and apolipoprotein B (ApoB) were significantly associated with better ORR. Moreover, early elevated CHO, LDL-C, and ApoA-I were also positively correlated with DOR and PFS. Further multivariate analysis showed that only early change in ApoA-I could independently predict PFS (HR, 2.27; 95% CI, 1.11-4.61; p = 0.034). The median PFS for patients with early elevated and reduced ApoA-I was 11.43 and 1.89 months, respectively. However, baseline lipids levels do not play a significant role in the prognosis and prediction of patients with anti-PD-1 treatment. CONCLUSION Collectively, an early elevation in ApoA-I was correlated with better outcomes for anti-PD-1 therapy in patients with R/M NPC, suggesting that clinicians should consider the early alteration of ApoA-I as a useful marker in treating R/M NPC patients with anti-PD-1.
Collapse
Affiliation(s)
- Bi Jing Xiao
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xiao Xian Sima
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Gang Chen
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Haimiti Gulizeba
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ting Zhou
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yan Huang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapySun Yat‐sen University Cancer CenterGuangzhouChina
| |
Collapse
|
3
|
Yang Y, Zhou T, Chen X, Li J, Pan J, He X, Lin L, Shi YR, Feng W, Xiong J, Yang K, Yu Q, Zhang Q, Hu D, Sun Y, Hu G, Li P, Shen L, Lin Q, Zhang B, Qu X, Zou J, Zhang L, Fang W, Zhao Y. Efficacy, safety, and biomarker analysis of Camrelizumab in Previously Treated Recurrent or Metastatic Nasopharyngeal Carcinoma (CAPTAIN study). J Immunother Cancer 2021; 9:e003790. [PMID: 34933967 PMCID: PMC8693086 DOI: 10.1136/jitc-2021-003790] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the antitumor activity of camrelizumab, an antiprogrammed cell death-1 antibody, in pretreated recurrent or metastatic nasopharyngeal carcinoma (NPC) and to explore predictive biomarkers. METHODS Patients with recurrent (not amenable to locally curative treatment) or metastatic NPC who had failed at least two lines of chemotherapy were eligible to receive camrelizumab (200 mg intravenously every 2 weeks) for 2 years or until disease progression, intolerable adverse events, withdrawal of consents, or investigator decision. The primary endpoint was objective response rate (ORR) assessed by an independent review committee (IRC). Programmed cell death-ligand 1 (PD-L1) expression was assessed by immunohistochemistry. Other immune-related biomarkers including major histocompatibility complex class I and major histocompatibility complex class II (MHC-II) were assessed by multiplex immunofluorescence staining. RESULTS Between August 14, 2018, and December 30, 2019, a total of 156 patients were enrolled. The IRC-assessed ORR was 28.2% (95% CI 21.3% to 36.0%). The median progression-free survival was 3.7 months (95% CI 2.0 to 4.1) per IRC, and the median overall survival was 17.4 months (95% CI 15.2 to 21.9). The ORRs were 35.2% (95% CI 25.3% to 46.1%) vs 19.4% (95% CI 10.4% to 31.4%) in patients with tumor PD-L1 expression of ≥10% and<10%, respectively. Patients with durable clinical benefit (DCB), which was defined as complete response, partial response or stable disease of ≥18 weeks, had higher density of MHC-II+ cell in stroma than patients without DCB (median 868.1 (IQR 413.4-2854.0) cells/mm2 vs median 552.4 (IQR 258.4 to 1242.1) cells/mm2). MHC-II+ cell density did not correlate with PD-L1 expression, and a composite of high stromal MHC-II+ cell density and tumor PD-L1 expression further enriched patients who could benefit from camrelizumab. CONCLUSIONS Camrelizumab had clinically meaningful antitumor activity in patients with recurrent or metastatic NPC. The composition of both MHC-II+ cell density and PD-L1 expression could result in better patient selection.
Collapse
Affiliation(s)
- Yunpeng Yang
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ting Zhou
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaozhong Chen
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jingao Li
- Department of Head and Neck Radiotherapy, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China
| | - Jianji Pan
- Department of Head and Neck Radiation Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaohui He
- Department of Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Lizhu Lin
- Department of Oncology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Ying-Rui Shi
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Weineng Feng
- Department of Head, Neck and Thoracic Oncology, Foshan First People's Hospital, Foshan, China
| | - Jianping Xiong
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kunyu Yang
- Department of Head and Neck Oncology, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Qitao Yu
- Department of Respiratory Oncology, Guangxi Medical University Affiliated Tumor Hospital, Nanning, China
| | - Qunling Zhang
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Desheng Hu
- Department of Head and Neck Tumor Radiotherapy, Hubei Cancer Hospital, Wuhan, China
| | - Yan Sun
- Department of Radiotherapy, Beijing Cancer Hospital, Beijing, China
| | - Guangyuan Hu
- Department of Comprehensive Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Li
- Department of Head and Neck Oncology, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Qin Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ben Zhang
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Xiao Qu
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Jianjun Zou
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Li Zhang
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wenfeng Fang
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuanyuan Zhao
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
4
|
Abstract
Anti-differentiation non-coding RNA (ANCR), a long non-coding RNA, is involved in the development, progression and metastasis of various human cancers. However, its clinical significance in nasopharyngeal carcinoma (NPC) still remains unknown. This study aimed to investigate ANCR expression and its clinical significance in NPC.Totally, 96 NPC tissues and 24 non-cancerous nasopharyngeal mucosa tissues were used. The levels of ANCR were determined by qRT-PCR. Relationship of ANCR with patient clinical characteristics, disease-free survival and overall survival (OS) was evaluated.ANCR expression was increased in NPC tissues compared to non-cancerous nasopharyngeal mucosae. ANCR expression was significantly related to lymph node metastasis, clinical stage, and tumor differentiation (P < .05). Kaplan-Meier survival analysis revealed that high level of ANCR expression was significantly associated with poor disease-free survival but not with OS in NPC patients. Univariate analysis showed a significant association between increased ANCR expression and adverse OS (P < .05), but multivariate analysis suggested that ANCR could not be used as an independent prognostic factor for NPC patients.ANCR is involved in the development and progression of NPC, but whether it can be used as an effective therapeutic target for NPC needs further study.
Collapse
Affiliation(s)
- Chengbing Guo
- Department of Otorhinolaryngology, Dantu District People's Hospital, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu Province, P.R. China
| | - Xingkai Ma
- Department of Otorhinolaryngology, Zhangjiagang First People's hospital, Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P.R. China
| | - Hailin He
- Department of Otorhinolaryngology, Dantu District People's Hospital, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu Province, P.R. China
| | - Yanhua Li
- Department of Otorhinolaryngology, Dantu District People's Hospital, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu Province, P.R. China
| | - Jieyu Zhou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| |
Collapse
|
5
|
Abstract
Breast metastases from extra-mammary neoplasms are rare, accounting for <2% of breast cancer cases. A 43-year-old female patient presented with a mass in her left breast and swelling in her left axillary region. A histopathological examination of the mass showed enlarged polygonal tumor cells with scant to moderate, eosinophilic to amphophilic cytoplasm and enlarged, hyperchromatic and pleomorphic nuclei with irregular nuclear membranes. An immunohistochemistry (IHC) examination was positive for pan cytokeratin and negative for CK7, CK20, S-100, LCA, HMB45, CD 20, desmin, myogenin, GCFDP-15, transcription factor-1, villin, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2. As she was a known case of nasopharyngeal carcinoma, and based on the histopathology findings and IHC profile, the patient was diagnosed with breast metastasis from NPC. The patient was deceased 3 months after refusing the recommended medical intervention.
Collapse
Affiliation(s)
- Abdulkader M Albasri
- Department of Pathology, Faculty of Medicine, Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. E-mail.
| |
Collapse
|
6
|
Wang FH, Wei XL, Feng J, Li Q, Xu N, Hu XC, Liao W, Jiang Y, Lin XY, Zhang QY, Yuan XL, Huang HX, Chen Y, Dai GH, Shi JH, Shen L, Yang SJ, Shu YQ, Liu YP, Wang W, Wu H, Feng H, Yao S, Xu RH. Efficacy, Safety, and Correlative Biomarkers of Toripalimab in Previously Treated Recurrent or Metastatic Nasopharyngeal Carcinoma: A Phase II Clinical Trial (POLARIS-02). J Clin Oncol 2021; 39:704-712. [PMID: 33492986 PMCID: PMC8078488 DOI: 10.1200/jco.20.02712] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE As yet, no checkpoint inhibitor has been approved to treat nasopharyngeal carcinoma (NPC). This study was aimed to evaluate the antitumor activity, safety, and biomarkers of toripalimab, a new programmed death-1 (PD-1) inhibitor for recurrent or metastatic NPC (RM-NPC) refractory to standard chemotherapy. PATIENTS AND METHODS In this single-arm, multicenter phase II study, patients with RM-NPC received 3 mg/kg toripalimab once every 2 weeks via intravenous infusion until confirmed disease progression or unacceptable toxicity. The primary end point was objective response rate (ORR). The secondary end points included safety, duration of response (DOR), progression-free survival (PFS), and overall survival (OS). RESULTS Among all 190 patients, the ORR was 20.5% with median DOR 12.8 months, median PFS 1.9 months, and median OS 17.4 months. Among 92 patients who failed at least two lines of systemic chemotherapy, the ORR was 23.9%. The ORRs were 27.1% and 19.4% in PD-L1+ and PD-L1- patients, respectively (P = .31). Patients with ≥ 50% decrease of plasma Epstein-Barr virus (EBV) DNA copy number on day 28 had significantly better ORR than those with < 50% decrease, 48.3% versus 5.7% (P = .0001). Tumor mutational burden had a median value of 0.95 muts/mega-base in the cohort and had no predictive value for response. Whole-exome sequencing results from 174 patients revealed that the patients with genomic amplification in 11q13 region or ETV6 genomic alterations had poor responses to toripalimab. CONCLUSION The POLARIS-02 study demonstrated a manageable safety profile and durable clinical response of toripalimab in patients with chemorefractory metastatic NPC. An early decrease in plasma EBV DNA copy number correlated with favorable response.
Collapse
Affiliation(s)
- Feng-Hua Wang
- Department of Medical Oncology of Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Li Wei
- Department of Medical Oncology of Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jifeng Feng
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Qi Li
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nong Xu
- The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xi-Chun Hu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wangjun Liao
- Cancer Center of Nan Fang Hospital, Guangzhou, China
| | - Yi Jiang
- The Affiliated Cancer Hospital of Shantou University, Shantou, China
| | - Xiao-Yan Lin
- Union Hospital of Fujian Medical University, Fuzhou, China
| | - Qing-yuan Zhang
- The affiliated Cancer Hospital of Harbin Medical University, Harbin, China
| | | | | | - Ye Chen
- Cancer Center of West China Hospital of Sichuan University, Chengdu, China
| | | | | | - Lin Shen
- Beijing Cancer Hospital & Institute, Beijing, China
| | | | | | - Yun-Peng Liu
- The First Hospital of China Medical University, Shenyang, China
| | | | - Hai Wu
- Shanghai Junshi Biosciences Co, Ltd, Shanghai, China
| | - Hui Feng
- Shanghai Junshi Biosciences Co, Ltd, Shanghai, China
| | - Sheng Yao
- Shanghai Junshi Biosciences Co, Ltd, Shanghai, China
| | - Rui-Hua Xu
- Department of Medical Oncology of Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
7
|
Hu W, Yao W, Li H, Chen L. MiR-30e-5p inhibits the migration and invasion of nasopharyngeal carcinoma via regulating the expression of MTA1. Biosci Rep 2020; 40:BSR20194309. [PMID: 32458989 PMCID: PMC7253402 DOI: 10.1042/bsr20194309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022] Open
Abstract
The study explored the effect of miR-30e-5p on nasopharyngeal carcinoma (NPC). MiR-30e-5p levels in NPC cancer and adjacent normal samples, in metastatic and non-metastatic cancer samples of NPC, and in NP69 cell and five NPC cell lines were determined by quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between miR-30e-5p and MTA1 was confirmed by dual-luciferase reporter assay, Western blot and qRT-PCR. The viability, migration and invasion of 5-8F and 6-10B cells were determined by CCK-8, scratch test and transwell assays, respectively. The levels of migration-related proteins (vimentin and Snail) and invasion-related proteins (MMP2 and MMP3) in NPC cells were detected by Western blot. The results showed that low expression of miR-30e-5p was associated with HNSC cancer, NPC, metastasis of NPC and NPC cell lines. Overexpressed miR-30e-5p in HNSC cancer and NPC was predictive of a better prognosis of patients. In addition, the viability, migration and invasion were reduced by up-regulating miR-30e-5p in 5-8F cells, but promoted by down-regulated miR-30e-5p in 6-10B cells. MiR-30e-5p reversed the migration and invasion of NPC cells regulated by MTA1, and inhibited migration and invasion of NPC cells via regulating MTA1 expression.
Collapse
Affiliation(s)
- Weiqun Hu
- Department of Otorhinolaryngology, The Affiliated Hospital of Putian University, China
| | - Wenfeng Yao
- Department of Otorhinolaryngology, Xinxiang First People’s Hospital, China
| | - Haolin Li
- Department of Otorhinolaryngology, Xinxiang First People’s Hospital, China
| | - Li Chen
- Department of Otorhinolaryngology, Zaozhuang Municipal Hospital, China
| |
Collapse
|
8
|
Abstract
To evaluate the benefits and risks of hepatic artery infusion (HAI) gemcitabine and floxuridine (FUDR) in patients with nasopharyngeal carcinoma liver metastases. HAI catheter systems were implanted under the guide of digital subtract angiography (DSA) in 16 patients with unresectable nasopharyngeal carcinoma liver metastases. HAI gemcitabine and FUDR in combination with radiotherapy and systemic chemotherapy were delivered. Disease control rate (DCR) of intrahepatic lesions is 100%, objective response rate (ORR) of intrahepatic lesions is 87.5%, including 4 patients (25%) with complete response (CR), 10 patients (62.5%) with partial response (PR) and 2 patients (12.5%) with stable disease (SD). The median overall survival (mOS) was 30 months. There was no significant difference between patients with < 9 intrahepatic lesions and patients with ≥ 9 intrahepatic lesions (31 months vs. 24 months, P = 0.562). Patients without extrahepatic metastases has longer survival than patients with extrahepatic metastases (31 months vs. 17 months, P = 0.005). In all 72 cycles of HAI, the main grade 3/4 toxicities related to HAI include: leukopenia occur in 8 cycles (11.1%), thrombocytopenia in 5 cycles (6.9%), AST/ALT elevation in 12 cycles (16.7). Catheter related complications occurred in 2 patients (12.5%). HAI gemcitabine and FUDR is effective to improve DCR of intrahepatic lesions and prolong mOS for patients with nasopharyngeal carcinoma liver metastases, and is associated with a relative low rate of toxicity.
Collapse
Affiliation(s)
- Changli Peng
- Radiological Intervention Center, Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Chunhui Zhou
- Radiological Intervention Center, Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Gang Li
- Radiological Intervention Center, Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Haiping Li
- Radiological Intervention Center, Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Liangrong Shi
- Radiological Intervention Center, Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
| |
Collapse
|
9
|
Liu Y, Chen S, Dong A, Ai F, Quan T, Cui C, Zhou J, Liang S, Wang J, Wang S, Hua L, Xu S, Chen M, Sun Y, Li H, Liu L. Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy. Eur Radiol 2019; 30:2115-2124. [PMID: 31811429 DOI: 10.1007/s00330-019-06537-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/06/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study aimed to evaluate the value of nodal grouping (NG), defined as the presence of at least three contiguous lymph nodes (LNs) within one LN region, in staging and management of patients with non-metastatic nasopharyngeal carcinoma (NPC). METHODS MR images were reviewed to evaluate LN variables, including NG. The Kaplan-Meier method and multivariate Cox regression models evaluated the association between the variables and survival. Harrell's concordance index (C-index) was used to measure the performance of prognostic models. The outcome of induction chemotherapy (IC) in patients with and without NG was compared using matched-pair analysis. RESULTS In 1224 patients enrolled, NG was found to be an independent prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival. The hazard ratio and 95% confidence interval (CI) of NG for OS (3.86, 2.09-7.12) were higher than those of stage N2 (3.54, 1.89-6.70). On upgrading patients with NG from stages N1 to N2, the revised N staging yielded a higher C-index compared to the American Joint Committee on Cancer system in predicting PFS (0.664 vs. 0.658, p = 0.022) and DMFS (0.699 vs. 0.690, p = 0.005). Results of the matched-pair analysis revealed that for patients with NG in stages N1 and N2, IC was correlated with improved OS (p = 0.022), PFS (p = 0.007), and DMFS (p = 0.021). CONCLUSIONS NG is a significant prognostic factor for patients with NPC. Patients with NG may be upgraded from stages N1 to N2. NG was also a marker for identifying patients who would benefit from IC. KEY POINTS • Nodal grouping, defined as the presence of at least three contiguous LNs within one LN region on MRI, was identified as a significant prognostic factor. • In patients with nasopharyngeal carcinoma, nodal grouping may influence lymph node staging. • Nodal grouping was a marker for identifying patients who may benefit from induction chemotherapy.
Collapse
Affiliation(s)
- Yifei Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Shenghuan Chen
- Department of Radiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, People's Republic of China
| | - Annan Dong
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Fei Ai
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Tingting Quan
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Chunyan Cui
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jian Zhou
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Shaobo Liang
- Department of Radiation Oncology, First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Jiamin Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shunxin Wang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ling Hua
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shuoyu Xu
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Mingyuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
| |
Collapse
|
10
|
Jin C, Zheng H, Zhan M, Wen F, Xu T. Cost-effectiveness analysis of gemcitabine plus cisplatin versus fluorouracil plus cisplatin in the first-line setting for Chinese patients with metastatic nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2019; 277:577-584. [PMID: 31720816 DOI: 10.1007/s00405-019-05714-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/23/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE A randomized phase III trial demonstrated that gemcitabine plus cisplatin (GP) prolonged progression-free survival and overall survival compared with fluorouracil plus cisplatin (FP) as first-line chemotherapy in patients with metastatic nasopharyngeal carcinoma (NPC). The cost-effectiveness analysis was designed to identify the economic option for metastatic NPC from a Chinese societal perspective. METHODS We established a Markov model that involved three health states representing the stages of disease to simulate therapy. Survival data of clinical outcomes were derived from the trial and adjusted to quality-adjusted life years (QALYs). Transition probabilities and health utilities were obtained from the clinical trial and published literatures. The cost-effective strategy was estimated for these treatments using a willing-to-pay (WTP) threshold. A one-way sensitivity analysis was conducted to study the influences of parameters. RESULTS GP treatment group produced a gain of 0.37 QALYs with an incremental cost of $2520.80, yielding an incremental cost-effectiveness ratio (ICER) of $6812.97 per QALY, compared with FP treatment ($15,530.96 versus $13,010.16). The ICER was lower than the accepted WTP threshold, which was 3 times gross domestic product per capita of China ($25,749 per QALY). CONCLUSION GP regimen is more cost-effective compared with FP regimen as the first-line treatment for Chinese patients with metastatic NPC.
Collapse
Affiliation(s)
- Chaohui Jin
- Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Hanrui Zheng
- Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Zhan
- Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Wen
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China
| | - Ting Xu
- Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
11
|
Mesia R, Bossi P, Hansen AR, Hsieh CY, Licitra LF, Tan EH, Chen P, Miller J, Siu LL, Haddad RI. Phase II study of CC-486 (oral azacitidine) in previously treated patients with locally advanced or metastatic nasopharyngeal carcinoma. Eur J Cancer 2019; 123:138-145. [PMID: 31698327 DOI: 10.1016/j.ejca.2019.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/11/2019] [Accepted: 10/01/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Treatment options are limited for recurrent nasopharyngeal carcinoma (NPC). We report results from a phase II study of CC-486 (oral azacitidine) in advanced NPC. PATIENTS AND METHODS Patients with locally advanced or metastatic NPC and 1-2 prior treatment regimens received CC-486 300 mg daily on days 1-14 of 21-day cycles until disease progression or unacceptable toxicity. The first 6 patients of Asian-Pacific Islander (API) ethnicity received a reduced dose of 200 mg to preserve safety and tolerability; if well tolerated, subsequent API patients received CC-486 300 mg. The study could advance to stage 2 if > 4 patients achieved a response. Co-primary end-points were overall response rate (ORR) and progression-free survival (independent review). Key secondary end-points were overall survival and safety. RESULTS Owing to faster-than-anticipated enrolment, 36 patients, including 13 of API ethnicity, were enrolled; the median age was 54.0 years. Most patients were male (81%) and had an Eastern Cooperative Oncology Group performance status ≤ 1 (97%). Among 25 efficacy-evaluable patients, the ORR was 12%; the median progression-free and overall survival were 4.7 and 18.0 months, respectively. The most common grade III/IV treatment-emergent adverse events were neutropenia (33%) and febrile neutropenia (11%). Twenty-one posttreatment deaths, primarily due to progressive disease or disease complications, and 1 on-treatment death (epistaxis, unrelated to study drug) occurred. The study did not advance to stage 2. CONCLUSION CC-486 did not show sufficient clinical activity to support further development as monotherapy in this patient population. The safety profile of CC-486 in NPC was consistent with that in other solid tumours.
Collapse
Affiliation(s)
- Ricard Mesia
- Department of Medical Oncology, B-ARGO Group, Institut Català d'Oncologia (ICO), Badalona, Spain.
| | - Paolo Bossi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Lisa F Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; University of Milan, Milan, Italy
| | | | - Peng Chen
- Celgene Corporation, Summit, NJ, USA
| | | | - Lilian L Siu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert I Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
12
|
Wang J, Qing G, Ou X, Hu W, Hu C, Zhang Z. The impact of target dosimetry on patients' locoregional recurrence in nasopharyngeal carcinoma: A propensity score-matched analysis. Radiother Oncol 2019; 141:67-71. [PMID: 31547944 DOI: 10.1016/j.radonc.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To analyze the impact of target dosimetry using propensity score matching (PSM) on patients' locoregional recurrence for nasopharyngeal carcinoma (NPC) and to find significant dose-volume factors of recurrence. METHODS Sixty-eight nasopharyngeal carcinoma (NPC) patients with recorded locoregional recurrence were enrolled in this study. These patients were treated with IMRT in 2009-2010 in our department. Another 198 NPC patients without recurrence were randomly selected from the same treatment time period. The median follow-up time for all patients was 49.0 months. PSM was performed to match the recurrence and nonrecurrence cohorts. Dose-volume histograms (DVHs) of treatment planning were extracted for statistical analysis. Cox hazard model and Kaplan-Meier log-rank analysis were performed to evaluate correlations between PTV dose coverage and local/region recurrence. RESULTS Propensity score matching balanced the clinical factors in two matches. Univariate cox survival model showed D90 and D95 were significantly correlated to the recurrence, and the D90 was the most significant (p = 0.036) one. The results of multivariate analysis show that only D90 is required for recurrence prediction when collinear dosimetric factors are considered. KM log-rank analysis showed that patients have significant local/regional control differences (p-value = 0.036, log-rank) in the D90 >101% and D90 <101% groups. CONCLUSION D90 corresponds to significant dose-volume factors. PTV dose coverage has a significant impact on locoregional recurrence in NPC clinical routine patients.
Collapse
Affiliation(s)
- Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Gan Qing
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Xiaomin Ou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China.
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China.
| |
Collapse
|
13
|
Abstract
BACKGROUND The purpose of the present study was to investigate the role of the methylation status of the DACT1 gene on the invasion and metastasis of nasopharyngeal carcinoma cells. METHODS The levels of methylation and expression of the DACT1 gene in nasopharyngeal carcinoma tissues and CNE2 cells were determined by methylation-specific PCR and RT-PCR, respectively. CNE2 cells were treated with 5-aza-2-deoxycytidine, and the variation in the methylation status of the DACT1 gene was detected, as well as the influence of methylation on invasiveness of nasopharyngeal carcinoma cells. RESULTS The DACT1 gene was hyper-methylated in 44 of 62 cases of nasopharyngeal carcinoma. The DACT1 gene was hyper-methylated in 32 of 38 cases of nasopharyngeal carcinoma with lymph node metastasis, and the DACT1 gene was hyper-methylated in 7 of 24 cases of nasopharyngeal carcinoma without lymph node metastasis. The DACT1 mRNA level was weakly expressed or not expressed in all nasopharyngeal carcinoma tissues with hyper-methylated DACT1 genes; however, the DACT1 mRNA level was highly expressed in nasopharyngeal carcinoma tissues with low expression of the methylated DACT1 gene. The DACT1 gene was hyper-methylated and not expressed in CNE2 cells that did not have 5-aza-2-deoxycytidine treatment. After 5-aza-2-deoxycytidine treatment, the DACT1 gene was demethylated and the expression of DACT1 was restored. Moreover, the invasion ability was inhibited in CNE2 cells treated with 5-aza-2-deoxycytidine. CONCLUSION The expression of DACT1 was related to the methylation status. High expression of DACT1 may inhibit the invasion and metastasis of nasopharyngeal carcinoma cells.
Collapse
Affiliation(s)
- Ju-Hong Yang
- Central Laboratory, University of Chinese Academy Sciences-Shenzhen Hospital, Song Bai Road 4253#, Shenzhen, 518106 Guang Dong People’s Republic of China
| | - Lie-Kun Lin
- Central Laboratory, University of Chinese Academy Sciences-Shenzhen Hospital, Song Bai Road 4253#, Shenzhen, 518106 Guang Dong People’s Republic of China
| | - Song Zhang
- Department of Otolaryngology, University of Chinese Academy Sciences-Shenzhen Hospital, Song Bai Road 4253#, Shenzhen, 518106 Guang Dong People’s Republic of China
| |
Collapse
|
14
|
Zhao C, Miao J, Shen G, Li J, Shi M, Zhang N, Hu G, Chen X, Hu X, Wu S, Chen J, Shao X, Wang L, Han F, Mai H, Chua MLK, Xie C. Anti-epidermal growth factor receptor (EGFR) monoclonal antibody combined with cisplatin and 5-fluorouracil in patients with metastatic nasopharyngeal carcinoma after radical radiotherapy: a multicentre, open-label, phase II clinical trial. Ann Oncol 2019; 30:637-643. [PMID: 30689735 DOI: 10.1093/annonc/mdz020] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We conducted a single-arm phase II trial to evaluate the efficacy and adverse effects (AEs) of an anti-epidermal growth factor receptor monoclonal antibody, nimotuzumab, combined with cisplatin and 5-fluorouracil (PF) as first-line treatment in recurrent metastatic nasopharyngeal carcinoma after radical radiotherapy. METHODS Patients who met the eligibility criteria were recruited from ten institutions (ClinicalTrials.gov; NCT01616849). A Simon optimal two-stage design was used to calculate the sample size. All patients received weekly nimotuzumab (200 mg) added to cisplatin (100 mg/m2 D1) and 5-fluorouracil (4 g/m2 continuous infusion D1-4) every 3-weekly for a maximum of six cycles. Primary end point was objective response rate (ORR). Secondary end points included disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and AEs. RESULTS A total of 35 patients were enrolled (13 in stage 1 and 22 in stage 2). Overall ORR and DCR were 71.4% (25/35) and 85.7% (30/35), respectively. Median PFS and OS were 7.0 (95% CI 5.8-8.2) months and 16.3 (95% CI 11.4-21.3) months, respectively. Unplanned exploratory analyses suggest that patients who received ≥2400 mg nimotuzumab and ≥4 cycles of PF had superior ORR, PFS and OS than those who did not (88.9% versus 12.5%, P < 0.001; 7.4 versus 2.7 months, P = 0.081; 17.0 versus 8.0 months, P = 0.202). Favourable subgroups included patients with lung metastasis [HROS 0.324 (95% CI 0.146-0.717), P = 0.008] and disease-free interval of >12 months [HROS 0.307 (95% CI 0.131-0.724), P = 0.004], but no difference was observed for metastatic burden. The only major grade 3/4 AE was leukopenia (62.9%). CONCLUSION Combination nimotuzumab-PF chemotherapy demonstrates potential efficacy, and is well tolerated as first-line chemotherapy regimen in recurrent metastatic nasopharyngeal carcinoma.
Collapse
Affiliation(s)
- C Zhao
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Centre, Zhongnan Hospital of Wuhan University, Wuhan; Department of Nasopharyngeal Carcinoma, 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
| | - J Miao
- Department of Nasopharyngeal Carcinoma, 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
| | - G Shen
- Department of Radiotherapy, Cancer Center of Guangzhou Medical University, Guangzhou; Department of Radiation Oncology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - J Li
- Department of Radiation Oncology, Jiangxi Province Tumour Hospital, Nanchang
| | - M Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an
| | - N Zhang
- Department of Radiation Oncology, The First People's Hospital of Foshan, Foshan
| | - G Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - X Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou
| | - X Hu
- Department of Radiation Oncology, The First People's Hospital of Foshan, Foshan
| | - S Wu
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou
| | - J Chen
- Departments of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning
| | - X Shao
- Department of Radiotherapy, Cancer Center of Guangzhou Medical University, Guangzhou
| | - L Wang
- Department of Nasopharyngeal Carcinoma, 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
| | - F Han
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou
| | - H Mai
- Department of Nasopharyngeal Carcinoma, 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
| | - M L K Chua
- Division of Radiation Oncology, Division of Medical Sciences, National Cancer Centre Singapore; Oncology Academic Programme, Duke-NUS Medical School, Singapore.
| | - C Xie
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Centre, Zhongnan Hospital of Wuhan University, Wuhan.
| |
Collapse
|
15
|
张 璐, 罗 小, 莫 笑, 黄 文, 梁 长, 张 水. [Development and validation of a multivariate risk model for distant metastasis of advanced nasopharyngeal carcinoma]. Nan Fang Yi Ke Da Xue Xue Bao 2018; 38:1459-1464. [PMID: 30613014 PMCID: PMC6744206 DOI: 10.12122/j.issn.1673-4254.2018.12.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To develop a model based on the clinical variables for evaluating the risk of distant metastasis in patients with advanced nasopharyngeal carcinoma (NPC). METHODS From September,2007 to June,2015,a total of 238 consecutive patients with biopsy-proven NPC in stage Ⅲ-Ⅳ(M0) based on the AJCC TNM staging manual were enrolled in this study,including 106 male and 34 female patients with a median age of 45 years (range 18-68 years).In this cohort,126 patients received concurrent chemoradiotherapy,and 24 received chemotherapy and radiotherapy,and 40 had induction chemotherapy.We used the least absolute shrinkage and selection operator (LASSO) method to select the most significant features for establishing the model for assessing the risks of distant metastasis. RESULTS Among the 18 clinical variables tested,5 were significantly associated with distant metastasis in advanced NPC,including plasma Epstein-Barr virus (EBV) DNA,neutrophil/lymphocytes (NLR),VCA-IgA,concurrent chemoradiotherapy,and induction chemotherapy.Based on these 5 clinical variables,we established the following model:risk score=1.73×EBV DNA+0.54×NLR+0.38×VCA-IgA-0.95×concurrent chemoradiotherapy-2.37×induction chemotherapy+0.51.The cutoff point of this model was-0.62,which classified the patients into high-risk and low-risk groups for distant metastasis.This model showed a good performance in predicting distant metastasis in patients with advanced NPC (P<0.01). CONCLUSIONS The model we established herein can be used for evaluating the risks of distant metastasis in patients with advanced NPC and provides assistance in the clinical decision-making on individualized treatment strategy.
Collapse
Affiliation(s)
- 璐 张
- 南方医科大学第二临床医学院,广东 广州 510515Graduate College, Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- 广东省人民医院//广东省医学科学院,广东 广州 510282Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou 510282, China
| | - 小宁 罗
- 南方医科大学第二临床医学院,广东 广州 510515Graduate College, Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- 广东省人民医院//广东省医学科学院,广东 广州 510282Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou 510282, China
| | - 笑开 莫
- 广东省人民医院//广东省医学科学院,广东 广州 510282Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou 510282, China
| | - 文慧 黄
- 广东省人民医院//广东省医学科学院,广东 广州 510282Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou 510282, China
| | - 长虹 梁
- 南方医科大学第二临床医学院,广东 广州 510515Graduate College, Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- 广东省人民医院//广东省医学科学院,广东 广州 510282Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou 510282, China
| | - 水兴 张
- 南方医科大学第二临床医学院,广东 广州 510515Graduate College, Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
- 广东省人民医院//广东省医学科学院,广东 广州 510282Department of Radiology, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou 510282, China
| |
Collapse
|
16
|
Wen X, Liu X, Mao YP, Yang XJ, Wang YQ, Zhang PP, Lei Y, Hong XH, He QM, Ma J, Liu N, Li YQ. Long non-coding RNA DANCR stabilizes HIF-1α and promotes metastasis by interacting with NF90/NF45 complex in nasopharyngeal carcinoma. Theranostics 2018; 8:5676-5689. [PMID: 30555573 PMCID: PMC6276287 DOI: 10.7150/thno.28538] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023] Open
Abstract
Long noncoding RNAs (lncRNAs) play an important role in the development and progression of cancers. However, the clinical significances of lncRNAs and their functions and mechanisms in nasopharyngeal carcinoma (NPC) remain largely unclear. Methods: Quantitative RT-PCR was used to determine DANCR expression and Kaplan-Meier curves were used to evaluate its prognostic value. RNA sequencing followed by bioinformatic analysis was performed to determine the potential function of DANCR. In vitro and in vivo experiments were conducted to investigate its biological effects. DANCR-interacting proteins were identified by RNA pull-down assay followed by mass spectrometry and western blotting, and then confirmed by RNA immunoprecipitation (RIP) assays. Results: Our previous microarray analysis identified a metastasis-associated lncRNA DANCR. Here, we found that DANCR was upregulated in NPC, especially in those with lymph lode metastasis, and its upregulation could predict poor survival. We then constructed a prognostic predictive model. RNA sequencing followed by bioinformatic analysis revealed that DANCR was responsible for NPC metastasis and hypoxia phenotype. Functional studies showed that DANCR promoted NPC cell invasion and metastasis in vitro and in vivo. Further investigation suggested that DANCR could increase HIF-1α mRNA stability through interacting with the NF90/NF45 complex. Additionally, overexpression of HIF-1α in DANCR knockdown cells restored its suppressive effects on NPC cell migration and invasion. Conclusions: Taken together, our results suggest that DANCR acts as a prognostic biomarker and increases HIF-1α mRNA stability by interacting with NF90/NF45, leading to metastasis and disease progression of NPC.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jun Ma
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Na Liu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Ying-Qin Li
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, No. 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| |
Collapse
|
17
|
Liu B, Tan Z, Jiang Y, Chen Y, Chen Y, Ling K. Correlation between the expression of miR150 and FOXO4 and the local recurrence and metastasis of nasopharyngeal carcinoma after intensive radiotherapy. J BUON 2018; 23:1671-1678. [PMID: 30610793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the relationship between the expression of miR150 and FOXO4 in nasopharyngeal carcinoma (NPC) and the local recurrence and metastasis after intensive radiotherapy. METHODS 94 patients with NPC were selected in Hunan Provincial People's Hospital from May 2011 to May 2013. All patients received intensive radiotherapy. Thirty healthy controls were also included. The expression levels of miR150 and FOXO4 mRNA in blood lymphocytes were detected by RT-PCR. All patients with NPC were followed up for 36 months. Blood was drawn from patients to analyze the expression of miR150 and FOXO4. MiR150 inhibitor was used to treat NPC cells, and FOXO4 overexpression cell lines were established. Transwell invasion assay was performed to investigate the effects of miR150 expression inhibition and FOXO4 overexpression on cell invasion. Protein levels were detected by western blot. RESULTS Compared with healthy controls, the levels of miR150 mRNA in NPC patients were significantly increased, while FOXO4 mRNA levels were significantly decreased (p<0.05). The levels of miR150 and FOXO4 were significantly correlated with distant metastasis and tumor recurrence (p<0.05). High expression level of miR150 or low expression level of FOXO4 significantly shortened the overall survival (OS) of patients (p<0.05). Cox's proportional hazards model showed that miR150 and FOXO4 were potential independent risk factors for NPC (p<0.05). The level of miR150 in patients with tumor recurrence was significantly higher than that in patients without tumor recurrence, while the level of FOXO4 in patients with tumor recurrence was lower than that patients without tumor recurrence (p<0.05). MiR150 expression inhibition or FOXO4 overexpression significantly reduced the invasion abilities of CNE1 and CNE2 cells and protein levels of matrix metalloproteinase2 (MMP2) and MMP9 (p<0.05). CONCLUSION MiR150 and FOXO4 are closely related to the metastasis and recurrence of NPC, and are independent prognostic factors for NPC. MiR150 and FOXO4 are of clinical significance in predicting NPC prognosis.
Collapse
Affiliation(s)
- Bin Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Hunan Provincial People's Hospital, Changsha 410005, P.R. China
| | | | | | | | | | | |
Collapse
|