Induction Chemotherapy Before Concurrent Chemoradiotherapy Improves OS in Nasopharyngeal Carcinoma

According to final analysis of a phase 3 trial, induction chemotherapy before concurrent chemoradiotherapy significantly improved overall survival (OS) in patients with locally advanced nasopharyngeal carcinoma.

The multicenter, phase 3 trial enrolled 480 patients between November 2013 and November 2018. Patients were randomized in a 1:1 ratio to receive either induction gemcitabine and cisplatin chemotherapy every 3 weeks for 3 cycles followed by concurrent chemoradiotherapy (intensity modulated-radiotherapy concurrently with cisplatin) every 3 weeks for 3 cycles (n = 242), or the standard care, concurrent chemoradiotherapy alone (n = 238). The primary end point was recurrence-free survival (RFS). Secondary end points included OS and toxic effects.

It was previously reported that the use of induction chemotherapy plus concurrent chemoradiotherapy significantly improved failure-free survival in this trial. At the median follow-up duration of 42.7 month, the 3-year RFS was 85.3% in the induction chemotherapy group, compared to 76.5% in the chemoradiotherapy alone group (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.34 to 0.77; P = .001).

This final analysis reported on OS results. With a median follow-up duration of 69.8 months, the induction chemotherapy group had a significantly higher 5-year OS at 87.9% compared to 78.8% in the chemoradiotherapy alone group (HR, 0.51; 95% CI, 0.34 to 0.78; P = .001). In addition, the risk of late toxicities was comparable between both groups. Grade ≥3 adverse events were seen in 11.3% of patients in the induction chemotherapy group compared to 11.4% in the concurrent radiotherapy group.

The study authors noted that the “depth of the tumor response to induction chemotherapy correlated significantly and positively with survival.” Those patients who saw a complete response had a 5-year OS of 100%, those who had a partial response had a 5-year OS of 88.4% and those with stable/progressive disease had a 5-year OS of 61.5% (P = 0.005). Therefore, tumor response to induction chemotherapy may be useful to guide individualized treatment.

Source:

Zhang Y, Chen L, Hu GQ, et al. Final overall survival analysis of gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma: A multicenter, randomized phase III trial. J Clin Oncol. 2022;40(22)2420-2425. doi:10.1200/JCO.22.00327.