Induction With Paclitaxel, Cisplatin, and Capecitabine vs Cisplatin and Fluorouracil for Nasopharyngeal Carcinoma

Study findings suggest induction therapy with paclitaxel, cisplatin, and capecitabine (TPC) is associated with a significant improvement in failure-free survival compared to cisplatin and fluorouracil (PF) in patients with late-stage nasopharyngeal carcinoma. However, there was no significant effect on early overall survival (OS).

“Induction chemotherapy added to concurrent chemoradiotherapy significantly improves survival for patients with locoregionally advanced nasopharyngeal carcinoma, but the optimal induction regimen remains unclear,” wrote lead author Wang-Zhong Li, MD, department of nasopharyngeal carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China, and coauthors.

In the multicenter, open label, phase 3, randomized clinical trial, 238 patients with treatment-naïve, nonkeratinizing stage IVA to IVB nasopharyngeal carcinoma and an Eastern Cooperative Oncology Group performance status of 0 to 1 were treated at 4 hospitals in China from October 20, 2016, to August 29, 2019. Patients received induction chemotherapy with either intravenous paclitaxel (150 mg/m², day 1), intravenous cisplatin (60 mg/m², day 1), and oral capecitabine (1000 mg/m² orally twice daily, days 1-14), or intravenous cisplatin (100 mg/m², day 1) and fluorouracil (800 mg/m² daily, days 1-5), followed by chemoradiotherapy. The median follow-up was 48.4 months.

In the TPC group, failure-free survival at 3 years was 83.5% (95% CI, 77.0% to 90.6%) compared with 68.9% (95% CI, 61.1% to 77.8%) in the PF group (stratified hazard ratio [HR] for recurrence or death, 0.47; 95% CI, 0.28 to 0.79; P = .004). Induction with the TPC regimen was also associated with a significant reduction in the risk of distant metastases (stratified hazard ratio [HR], 0.49 [95% CI, 0.24 to 0.98]; P = .04) and locoregional recurrence (stratified HR, 0.40 [95% CI, 0.18 to 0.93]; P = .03) compared with the PF regimen.

However, Dr Li and colleagues noted that there was no statistically significant effect on early overall survival (stratified HR, 0.45 [95% CI, 0.17 to 1.18]; P = .10).

Source:
Li WZ, Lv X, Hu D, et al. Effect of Induction Chemotherapy With Paclitaxel, Cisplatin, and Capecitabine vs Cisplatin and Fluorouracil on Failure-Free Survival for Patients With Stage IVA to IVB Nasopharyngeal Carcinoma: A Multicenter Phase 3 Randomized Clinical Trial. JAMA Oncol. Published online March 24, 2022. doi:10.1001/jamaoncol.2022.0122.