Induction Chemotherapy Docetaxel, Cisplatin, 5-Fluorouracil Followed by Concurrent Chemoradiotherapy in Stage IVA Nasopharyngeal Carcinoma

Edwin C Y Wong,Horace C.W Choi,Tommy C.Y So,K C Lee,Sarah W.M Lee,Jim P H Lam,Wai Tong Ng,Philip Y Wu

doi:10.31487/j.cor.2020.11.05

Abstract

Objectives: Two phase III studies using docetaxel, cisplatin and 5-fluorouracil (TPF) followed by concurrent chemoradiotherapy (CCRT) have reported survival benefit compared to CCRT. However, TPF was used at 80% of the conventional dose in the Chinese study due to the concern of tolerability. We aim to explore the tolerability of TPF using standard dose in Chinese patients with stage IVA (AJCC 8th edition) nasopharyngeal carcinoma and report on its preliminary efficacy. Methods: Consecutive patients treated with induction chemotherapy (IC) TPF followed by CCRT between 2017 and 2020 were reviewed. TPF regimen consisted of three cycles of Docetaxel 75 mg/m2 D1; Cisplatin 75 mg/m2 D1; 5-fluorouracil 750 mg/m2 D1-5 every 3 weeks; with G-CSF D7-11. Radiotherapy consisted of 70 Gy in 35 fractions with concomitant cisplatin 100 mg/m2 every 3 weeks. Results: 28 patients were identified. 92.8% patients completed three cycles of IC. 79% patients received concomitant cisplatin of ≥ 200 mg/m2 . The most common grade 3 or 4 acute toxicity was diarrhea (25%). Grade 3 or 4 neutropenia occurred in 10.7% of patients, of which only 3.6% resulted in febrile neutropenia. Median follow-up was 2 years. The 2-year overall survival, locoregional failure-free survival and distant failure-free survival were 100%, 96.4% and 91.3% respectively. Conclusion: IC using standard dose TPF was well tolerated in Chinese patients with manageable toxicities and allowed adequate delivery of subsequent concurrent cisplatin. Survival outcomes were encouraging and unnecessary dose reduction of TPF should be avoided.

Highlights

129,079 new cases of nasopharyngeal carcinoma (NPC) are diagnosed each year worldwide
We aim to explore the tolerability of TPF using standard dose in Chinese patients with stage IVA (AJCC 8th edition) nasopharyngeal carcinoma and report on its preliminary efficacy
Among the 2 patients who did not proceed with the last cycle TPF, one patient developed ST-elevation myocardial infarction (STEMI)

Summary

Introduction

129,079 new cases of nasopharyngeal carcinoma (NPC) are diagnosed each year worldwide. It has a unique endemic distribution affecting mainly Southeast Asia, in particular the southern regions of China [1]. A meta-analysis on the role of chemotherapy in NPC (MAC-NPC) reported in 2006 confirmed an absolute survival benefit of 6% and event free survival benefit of 10% at 5 years respectively, with the addition of chemotherapy [2]. Up to one in four patients with NPC present with non-metastatic stage IV disease, for which standard treatment produces distinct failure patterns. Patients with T4 disease carry high local and distant failure risk, with 5-year locoregional failure-free survival (LRFFS) and DFFS of 73%. Patients with N3 disease are at high risk of distant metastasis, with 5-year DFFS of 66%. New treatment directions to tackle these failure patterns are warranted [5, 6]

Objectives

Methods

Results

Conclusion