Clinical Progress of Adjuvant Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

Boya Xiao,Bicheng Wang,Zhanjie Zhang,Bohua Kuang,Rubo Cao

doi:10.54457/dr.202101001

Abstract

Concurrent chemoradiotherapy (CCRT) is the foundational standard-of-care for patients with locoregionally advanced nasopharyngeal carcinoma (LANPC). Adding adjuvant chemotherapy (AC) or induction chemotherapy (IC) to CCRT has been shown to benefit LANPC patients. During recent five years, large numbers of prospective randomized controlled clinical trials have demonstrated the superior efficacy of IC+CCRT than CCRT alone in LANPC patients. However, prospectively designed studies concerned with AC are limited. The efficacy of CCRT+AC in treating LANPC remains unclear. For better understanding and more properly clinical usages of AC, we reviewed the studies of CCRT+AC in the treatments for LANPC patients. In summary, adding AC to CCRT is a feasible therapeutic strategy for patients with EBV positive LANPC.

Highlights

Radiotherapy (RT) is the mainstay in the treatment of nasopharyngeal carcinoma (NPC)
Survivals are prolonged by concurrent chemoradiotherapy (CCRT) plus adjuvant chemotherapy (AC) compared with RT alone
In terms of AC, the National Comprehensive Cancer Network (NCCN) guideline prefers adding AC to CCRT, the results in the cited articles fail to indicate the superiority of CCRT+AC compared to CCRT.In Al-Sarraf’s study, locoregionally advanced nasopharyngeal carcinoma patients were treated CCRT plus cisplatin and fluorouracil AC versus RT alone [4]

Summary

Introduction

Radiotherapy (RT) is the mainstay in the treatment of nasopharyngeal carcinoma (NPC). In trials of IC, patients with locoregionally advanced NPC (LANPC) benefit more from IC+CCRT versus CCRT. 1. Additional Adjuvant Chemotherapy For Locoregioally Advanced Nasopharyngeal Carcinoma In National Comprehensive Cancer Network Guidelines. 2021), patients with stage II-IVa nasopharyngeal carcinoma are recommended to receive (1) clinical trials, (2) induction chemotherapy (IC) followed by systemic therapy/. RT, (3) concurrent systemic therapy/RT followed by AC, or (4) concurrent systemic therapy/RT not followed by AC [1] The recommendations of both IC+CCRT and CCRT+AC are category 2A, while CCRT is category 2B. It seems that the NCCN guideline prefers IC+CCRT and CCRT+AC other than CCRT in the treatment of LANPC. For IC+CCRT, numerous data have demonstrated the improvement of all survival outcomes versus CCR T alone in LANPC patients. The different categories of the recommendation of CCRT+AC and CCRT by NCCN guideline might not be reasonable and convincing

Regimens of adjuvant chemotherapy

Conclusions

Findings

The population of patients who benefited from adjvant chemotherapy