1. The failure-free-survival at 3 years for induction chemotherapy with paclitaxel, cisplatin and capecitabine group was 83.5% versus 68.9% in the cisplatin and fluorouracil group.
2. Common treatment-related adverse events in patients receiving paclitaxel, cisplatin and capecitabine were nephrotoxicity, hand-foot syndrome and allergic reaction.
Evidence Rating Level: 1 (Excellent)
Study Rundown: The current standard of care for non-metastatic nasopharyngeal carcinoma (NPC) is induction chemotherapy with concurrent chemoradiotherapy. However, there is limited knowledge on the optimal induction regimen for NPC. Therefore, this study aimed to compare the efficacy and safety of induction chemotherapy with paclitaxel, cisplatin and capecitabine (TPC) versus cisplatin and fluorouracil (PF) for patients with stage IVA to IVB NPC. In the intention-to-treat group, the failure-free-survival at 3 years for TPC group was 83.5% versus 68.9% in the PF group. Nephrotoxicity, hand-foot syndrome and allergic reaction were common treatment-related adverse events that were reported. The main limitation of the analyses included limited data for diverse ethnicities as the study was conducted in Chinese patients only. Overall, this study demonstrated support that TPC can be used as induction chemotherapy for stage IVA to IVB NPC. However, further investigation is required to examine the long-term survival and safety profile of this induction chemotherapy regimen.
Click to read the study in JAMA Oncology
Relevant Reading: Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomized controlled trial.
In-Depth [randomized controlled trial]: This was an open label, randomized, multi-center phase III study. A total of 238 patients were enrolled to receive either study treatment (n=118) or cisplatin and fluorouracil (n=120) induction chemotherapy. In addition, all patients received concurrent chemoradiotherapy with cisplatin. The demographic of both study groups were well-balanced. The median follow-up period was 48.4 months (interquartile range [IQR]: 39.6-53.3). The failure-free-survival at 3 years for the intention-to-treat population was 83.5% (95% confidence interval [CI]: 77.0%-90.6%) in the TPC group and 68.9% in the PF group (95% CI: 61.1%-77.8%). The stratified hazard ratio [HR] was 0.47 [95% CI: 0.28-0.79; p=0.004]. Common treatment-related adverse events of any grade for included nephrotoxicity (TPC: 94.9%, PF: 93.3%), hand-foot syndrome (TPC: 98.3%, PF: 99.2%) and allergic reaction (TPC: 94.9%, PF: 97.5%). 57.6% of the patients in the TPC group versus 13.6% in the PF group experienced grade 3-4 acute adverse events and late-onset toxicities. There was one treatment-related death in the PF group.
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