Induction Chemotherapy for Advanced Nasopharyngeal Carcinoma—Is This the New Standard of Care?
Mené en Chine sur 238 patients atteints d'un carcinome du rhinopharynx de stade IVA à IVB (âge médian : 45 ans ; durée médiane de suivi : 48,4 mois), cet essai de phase III évalue l'efficacité, du point de vue de la survie sans échec, et la toxicité d'une chimiothérapie d'induction à base de paclitaxel, cisplatine et capécitabine par rapport à une chimiothérapie combinant cisplatine et fluorouracile, avant une chimioradiothérapie
Nasopharyngeal carcinoma (NPC) has a distinct cause and geographic distribution predominantly seen in Southeast Asia. More than 50% of patients with NPC present with locally advanced disease with high risk for distant metastases and relapse. Hence, the quest to explore the role of sequential systemic therapies to improve regional and distant disease for patients with NPC became pertinent.
Three randomized phase 3 studies from China explored this query. In 2016, Sun et al1 examined the role of cisplatin, fluorouracil, and docetaxel (TPF) induction chemotherapy (IC) with concurrent chemoradiotherapy (CCRT) for patients with locoregionally advanced NPC in a randomized phase 3 trial in which the 3-year failure-free survival was 80% in the IC plus CCRT group compared with 72% in the CCRT alone group (hazard ratio, 0.68; P = .03). In 2019, Zhang et al2 demonstrated the addition of gemcitabine and cisplatin IC plus CCRT compared with CCRT alone for patients with locoregionally advanced NPC showed the 3-year recurrence-free survival was 85% vs 77%, with improved overall survival (95% vs 90%). In the same year, Yang et al3 examined the role of cisplatin and fluorouracil IC followed by CCRT with CCRT alone and noted an improved 5-year disease-free survival of 73% vs 63% and improved overall survival (81% vs 77%). These seminal randomized phase 3 trials have proven the efficacy and effect of induction chemotherapy, especially in stage III to IVA disease, on long-term patient outcomes.
JAMA Oncology , commentaire, 2021