Phase II: Concurrent cisplatin/radiotherapy followed by adjuvant cisplatin/docetaxel for locally advanced nasopharyngeal carcinoma

Abstract

5573 Background: Concurrent cisplatin and radiotherapy as well as docetaxel/cisplatin combination are highly active agents for locally advanced nasopharyngeal cancer (LANPXCA).The efficacy and tolerability of concurrent cisplatin/radiotherapy followed by adjuvant docetaxel/cisplatin are explored in a phase II study Methods: From May 2001 to Feb 2003, 17 patients with LANPXCA stage III-IV were treated with 2 cycles of 3 weekly cisplatin 100mg/m2 concurrently with radiotherapy aiming at 70Gy Gy/ 35 fraction/ 7 weeks. Three weeks post radiotherapy 4 cycles of adjuvant 3 weekly docetaxel 60mg/m2 1 hour IV infusion D1 and cisplatin 60mg/m2 2 hours IV infusion D1 with prophylactic G-CSF support as 5μg/kg s.c. D3–5 were added. The median follow up was 30.2 months (15.6 - 41.1). Results: The median age was 50 years (25–70) and male to female ratio was 4.3:1. Nasal obstruction 82.4%, neck swelling 76.5%, headache 70.6% and impaired hearing 52.9% were the commonest symptoms. The most common histopathologic grade was G3 squamous cell carcinoma 94.1%. The majority of patients were stage IV 70.6% while 29.4% were stage III, (AJCC, 1997). Patients with G2 ECOG performance status were 47.1% while 52.9% were G1. The treatment was tolerable with the commonest G3 acute toxicities were dysphagia 23.5%, oral mucositis 11.3%, dermatitis 11.3%, leukopenia 5.9% and thrombocytopenia 5.9% while the commonest late toxicity was G2 mouth dryness in 88.2%. Complete remission was achieved in 15/17 patients (88.2%) while 2/17 (11.8%) were partial responders. Failure sites were locoregional; parapharyngeal space 5.9% and cervical nodes 5.9%. The Kaplan Meyer 41- month disease free survival was 88.2% while the 41- month overall survival was 100%. Conclusions: Concurrent cisplatin with radiotherapy followed by adjuvant docetaxel/cisplatin combination chemotherapy appears to be an effective and tolerable outpatient treatment for LANPXCA. No significant financial relationships to disclose.