Is the Neoadjuvant Docetaxel, Cisplatin and 5-Fluorouracil Regimen Superior to Classic Cisplatin and 5-Fluorouracil for Locoregionally Advanced Nasopharyngeal Carcinoma?
DOI:
https://doi.org/10.6000/1929-2279.2013.02.04.8Keywords:
Nasopharyngeal carcinoma, induction-concurrent chemotherapy, docetaxel, cisplatin, 5-fluorouracil.Abstract
Objectives: We retrospectively compared the toxicity and efficacy of two neoadjuvant chemotherapy regimens (docetaxel+cisplatin+5-fluorouracil vs. cisplatin+5-fluorouracil) followed by chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma.
Patients and Materials: We analysed 135 patients with stage III and IVA-B nasopharyngeal carcinoma. Forty-four patients were treated with docetaxel+cisplatin+5-fluorouracil and chemoradiotherapy (TPF group), and 91 were treated with cisplatin+5-fluorouracil and chemoradiotherapy (PF group). Chemoradiotherapy was administered with weekly cisplatin. Radical radiotherapy with total doses of 70-74Gy was administered using a conventional technique, over 7 weeks in 2.0Gy/fraction; boost doses of 6-10Gy were administered in 55.6% patients (n=75) with locally advanced cancer.
Results: The median follow-up was 46.5 months (range, 9.8-62.8 months), and the follow-up rate was 95%. The TPF group had better 5-year estimated progression-free survival (77.0% vs. 73.5%; P = 0.510) and overall survival than the PF group (80.7% vs. 77.9%, P = 0.446); however, there was no statistically significant difference between the groups. Toxicities in the two groups were similar; grade 3/4 oral mucositis was more common in the TPF group (27.3%) than in the PF group (15.3%) during chemoradiotherapy.
Conclusions: The neoadjuvant docetaxel+cisplatin+5-fluorouracil chemotherapy led to satisfactory long-term survival and slight improvement in progression-free survival and overall survival as compared with the classic cisplatin+5-fluorouracil regimen; toxicity was tolerable. However, prospective trials are needed to prove whether docetaxel+cisplatin+5-fluorouracil is a substitute for cisplatin+5-fluorouracil.
References
Lee AW, Lin JC, Ng WT. Current management of nasopharyngeal cancer. Semin Radiat Oncol 2012; 22: 233-44. http://dx.doi.org/10.1016/j.semradonc.2012.03.008
Lu H, Peng L, Yuan X, et al. Concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma: a treatment paradigm also applicable to patients in Southeast Asia. Cancer Treat Rev 2009; 35: 345-53. http://dx.doi.org/10.1016/j.ctrv.2009.01.002
Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: Phase III randomized Intergroup study 0099. J Clin Oncol 1998; 16: 1310-7.
Chen L, Hu CS, Chen XZ, et al. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol 2012; 13: 163-71. http://dx.doi.org/10.1016/S1470-2045(11)70320-5
National comprehensive cancer network.
Al-Amro A, Al-Rajhi N, Khafaga Y, et al. Neoadjuvant chemotherapy followed by concurrent chemo-radiation therapy in locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2005; 62: 508-13. http://dx.doi.org/10.1016/j.ijrobp.2004.09.050
Lee AW, Lau KY, Hung WM, et al. Potential improvement of tumor control probability by induction chemotherapy for advanced nasopharyngeal carcinoma. Radiother Oncol 2008; 87: 204-10. http://dx.doi.org/10.1016/j.radonc.2008.02.003
Chua DT, Sham JS, Choy D, et al. Preliminary report of the Asian-Oceanian Clinical Oncology Association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. Cancer 1998, 83: 2270-83. http://dx.doi.org/10.1002/(SICI)1097-0142(19981201)83:11<2270::AID-CNCR6>3.3.CO;2-K
Ma J, Mai HQ, Hong MH, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol 2001; 19: 1350-7.
Cvitkovic E, Eschwege F, Rahal M, et al. Preliminary results of a randomized trial comparing neoadjuvant chemotherapy (cisplatin, epirubicin, bleomycin) plus radiotherapy vs. radiotherapy alone in stage Ⅳ (≥N2, M0) undifferentiated nasopharyngeal carcinoma: a positive effect on progression-free survival. Int J Radiat Oncol Biol Phys 1996; 35: 463- 469.
Hareyama M, Sakata K, Shirato H, et al. Prospective, randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in patients with advanced nasopharyngeal carcinoma. Cancer 2002; 94: 2217-23. http://dx.doi.org/10.1002/cncr.10473
Vermorken JB, Remenar E, van Herpen C, et al. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 2007; 357: 1695-704. http://dx.doi.org/10.1056/NEJMoa071028
Posner MR, Hershock DM, Blajman CR, et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 2007; 357: 1705-15. http://dx.doi.org/10.1056/NEJMoa070956
Johnson FM, Garden A, Palmer JL, et al. A phase II study of docetaxel and carboplatin as neoadjuvant therapy for nasopharyngeal carcinoma with early T status and advanced N status. Cancer 2004; 100: 991-98. http://dx.doi.org/10.1002/cncr.20079
Hui EP, Ma BB, Leung SF, et al. Randomized phase II trial of concurrent cisplatin-radiotherapy with or without neoadjuvant docetaxel and cisplatin in advanced nasopharyngeal carcinoma. J Clin Oncol 2009; 27: 242-49. http://dx.doi.org/10.1200/JCO.2008.18.1545
Bae WK, Hwang JE, Shim HJ, et al. Phase II study of docetaxel, cisplatin, and 5-FU induction chemotherapy followed by chemoradiotherapy in locoregionally advanced nasopharyngeal cancer. Cancer Chemother Pharmacol 2010; 65: 589-95. http://dx.doi.org/10.1007/s00280-009-1152-0
Bossi P, Orlandi E, Bergamini C, et al. Docetaxel, cisplatin and 5-fluorouracilbased induction chemotherapy followed by intensity-modulated radiotherapy concurrent with cisplatin in locally advanced EBV related nasopharyngeal cancer. Ann Oncol 2011; 22: 2495-500. http://dx.doi.org/10.1093/annonc/mdq783
Ekenel M, Keskin S, Basaran M, et al. Induction chemotherapy with docetaxel and cisplatin is highly effective for locally advanced nasopharyngeal carcinoma. Oral Oncol 2011; 47: 660-64. http://dx.doi.org/10.1016/j.oraloncology.2011.04.010
Lee AW, Tung SY, Ngan RK, et al. Factors contributing to the efficacy of concurrent-adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: Combined analyses of NPC-9901 and NPC-9902 Trials. Eur J Cancer 2011; 47: 656-66. http://dx.doi.org/10.1016/j.ejca.2010.10.026
Kong L, Zhang YW, Hu CS, Guo Y. Neoadjuvant chemotherapy followed by concurrent chemoradiation for locally advanced nasopharyngeal carcinoma. Chin J Cancer 2010; 29: 551-55. http://dx.doi.org/10.5732/cjc.009.10518
Du C, Ying H, Zhou J, Hu C, Zhang Y. Experience with combination of docetaxel, cisplatin plus 5-fluorouracil chemotherapy, and intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma. Int J Clin Oncol 2013; 18: 464-71. http://dx.doi.org/10.1007/s10147-012-0403-y
Xie FY, Qi SN, Hu WH, Zou GR, Peng M, Li JS. Comparison of efficacy of docetaxel combined cisplatin (TP regimen) and cisplatin combined 5-fluorouracil (PF regimen) on locally advanced nasopharyngeal carcinoma. Chin J Cancer 2007; 26: 880-4.
Guo L, Lin HX, Xu M, Chen QY, Wang CT, Huang PY. Phase I study of TPF neoadjuvant chemotherapy followed by radical radiotherapy in advanced nasopharyngeal carcinoma. Chin J Cancer 2010; 29: 136-39. http://dx.doi.org/10.5732/cjc.009.10367
Loong HH, Ma BB, Leung SF, et al. Prognostic significance of the total dose of cisplatin administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. Radiother Oncol 2012; 104: 300-4. http://dx.doi.org/10.1016/j.radonc.2011.12.022
Downloads
Published
How to Cite
Issue
Section
