Comparison of Gemcitabine Plus Cisplatin vs. Docetaxel Plus Fluorouracil Plus Cisplatin Palliative Chemotherapy for Metastatic Nasopharyngeal Carcinoma.

Xue-Song Sun,Sai-Lan Liu,Dong-Hua Luo,Li-Ting Liu,Rui Sun,Hai-Qiang Mai,Qiu-Yan Chen,Lin-Quan Tang,Xiao-Hao Wang,Shan-Shan Guo

doi:10.3389/fonc.2020.01295

Abstract

Objective: Our study aimed to compare the efficacy and toxicity of two chemotherapy regimens, gemcitabine plus cisplatin (GP) vs. docetaxel plus, fluorouracil plus cisplatin (TPF), in metastatic nasopharyngeal carcinoma (NPC) patients.Methods: We retrospectively enrolled metastatic NPC patients between July 2006 and December 2016 who were treated with TPF or GP palliative chemotherapy (PCT). The association between the PCT regimens and survival conditions was evaluated by log-rank tests and the Cox proportional hazards model. A cohort was created using propensity score matching with the ratio of 1:1 to clarify the results of the multivariable Cox regression analyses. Overall survival (OS) was the primary endpoint.Results: Of 266 eligible patients, 186 and 80 patients, respectively, received TPF and GP regimen. No significant difference was demonstrated in the survival rate between the GP and TPF groups (3-year OS: 52.6 vs. 50.3%; P = 0.929). However, multivariable analysis suggested receiving GP as an independent protective factor (hazard ratio, 0.864; 95% confidence interval, 0.753–0.992; P = 0.042). In the matched cohort, treatment with GP was also associated with a significantly higher OS (3-year OS: 52.6 vs. 35.6%, P = 0.042). Subgroup analysis indicated that the superiority of GP reflected in patients with secondary metastases rather than primary metastases. The incidence of grade 3 to 4 treatment-related toxicity was more common in the TPF group than in the GP group.Conclusion: Our study suggested that GP might be superior to TPF for metastatic NPC patients, especially those with secondary distant metastases. Further studies are necessary to validate our results.

Highlights

Nasopharyngeal carcinoma (NPC) is a kind of malignancy arising from the nasopharyngeal mucosal lining
Multivariable analysis indicated that compared with the PF (TPF), the administration of gemcitabine plus cisplatin (GP) was a protective factor for secondary metastatic NPC (HR, 0.797; 95% confidence intervals (CIs), 0.614–0.982; P = 0.022), but not for primary metastatic NPC patients (HR, 1.069; 95% CI, 0.855–1.337; P = 0.557) (Table 4)
GP could serve as first-line treatment for metastatic NPC patients, in particular for those with secondary metastases

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is a kind of malignancy arising from the nasopharyngeal mucosal lining. Different from other head and neck cancers, the incidence of NPC is obviously unbalanced across the world, with the highest incidence rate observed in South China [1]. Radiotherapy (RT) with or without chemotherapy is the standard treatment method for non-metastatic NPC [2, 3]. Distant metastases have become the main treatment failure and cause of death in NPC [4]. Approximately 15% of patients are detected to have distant metastases at the point of primary diagnosis [5]. Once distant lesions are present, the prognosis is poor, and treatment mainly relies on systemic palliative chemotherapy (PCT) [6]

Methods

Results

Discussion

Conclusion