Radiotherapy Alone After Chemotherapy Induction for Patients With Nasopharyngeal Carcinoma

According to results from phase 3 trial, radiotherapy alone, following induction chemotherapy, was noninferior to chemoradiotherapy in terms for 3-year progression-free survival among patients with locoregionally advanced nasopharyngeal carcinoma.

As Jinxuan Dai, MD, Affiliated Hospital of Guilin Medical University, Guilin, China, and coauthors wrote, “Induction chemotherapy plus concurrent chemoradiotherapy is recommended for locoregionally advanced nasopharyngeal carcinoma but is associated with higher rates of acute toxic effects and low compliance,” and “evidence on de-escalating treatment intensity…is limited.”

In this multicenter, open label, noninferiority phase 3 trial 383 patients with untreated stage III to IVB nasopharyngeal cancer were randomized to receive 3 cycles of induction chemotherapy (cisplatin, docetaxel, and fluorouracil), followed by either radiotherapy alone (n = 193) or concomitant cisplatin with radiotherapy (n = 190) for 6 to 7 weeks. The primary outcome was 3-year progression-free survival (PFS), with a noninferiority margin of 10%.

With a median follow-up duration of 76 months, the 3-year PFS was 76.2% in the radiotherapy alone group and 76.8% in the chemoradiotherapy group, in the intention-to-treat population (P = .01 for noninferiority). In the per protocol population, outcomes were reported to be identical. There were fewer instances of grade 3/4 short-term adverse events in the radiotherapy alone group compared with the chemoradiotherapy group. There were no differences reported in late toxic events.

According to Dr Dai et al, these results “suggest that after induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma, radiotherapy alone was noninferior to chemoradiotherapy in terms of 3-year progression-free survival.”

Source:

Dai J, Zhang B, Su Y, et al. Induction chemotherapy followed by radiotherapy vs chemoradiotherapy in nasopharyngeal carcinoma: A randomized clinical trial. JAMA Oncol. Published February 8, 2024. doi:10.1001/jamaoncol.2023.6552