Abstract
BackgroundDue to improvements in imaging and radiological techniques as well as the use of chemotherapy, distant metastasis has become the predominant mode of treatment failure in patients with locally advanced nasopharyngeal carcinoma (LA-NPC). Platinum-based systemic chemotherapy has shown survival benefits and is now the standard strategy for systemic therapy in patients with LA-NPC. Notably, the third-generation platinum reagent lobaplatin has shown anti-tumor effects in several solid tumors with lower incidences of gastrointestinal, hepatic and renal toxicity relative to other platinum drugs. However, the safety and efficacy of lobaplatin as a first-line regimen in patients with LA-NPC are undetermined.MethodsPatients with stage III–IVa-b NPC received lobaplatin at a dose of 30 mg/m2 on days 1 and 22 combined with a continuous 120-h intravenous injection of 5-fluorouracil at a dose of 4 g/m2 followed by lobaplatin at a dose of 50 mg/m2 on days 43 and 64 concomitant with intensity-modulated radiation therapy. Objective response rates and acute toxicity were assessed based on RECIST (1.1) and CTCAE v.3.0, respectively. Kaplan-Meier analysis was used to calculate survival rates.ResultsFifty-nine patients were enrolled, and 44 patients (74.6%) received allocated cycles of chemotherapy. The objective response rates were 88.1% (95% confidence interval [CI], 0.77 to 0.95) and 100% after induction chemotherapy (ICT) and concurrent chemoradiotherapy (CRT), respectively. With a median follow-up period of 44 months, the 3-year estimated progression-free survival and overall survival were 86.4% (95% CI, 69.8 to 98.8) and 94.9% (95% CI, 89.5 to 100), respectively. The most common grade 3–4 toxicities were neutropenia (8.5%) and thrombocytopenia (40.7%) after ICT and CRT, respectively.ConclusionLobaplatin combined with 5-fluorouracil followed by lobaplatin-RT treatment showed encouraging anti-tumor effects with tolerable toxicities in patients with LA-NPC. Randomized controlled trials of lobaplatin in patients with LA-NPC are warranted.Trial registrationThis trial was registered with the Chinese Clinical Trials Registry and approved on March 31st, 2012, number ChiCTR-ONC-12002060.
Highlights
Due to improvements in imaging and radiological techniques as well as the use of chemotherapy, distant metastasis has become the predominant mode of treatment failure in patients with locally advanced nasopharyngeal carcinoma (LA-Nasopharyngeal carcinoma (NPC))
Ma J et al recently demonstrated that the introduction of cisplatin, fluorouracil, and docetaxel (TPF) induction chemotherapy to concurrent chemotherapy could significantly improve the progression-free survival (PFS) of patients with locally advanced nasopharyngeal carcinoma (LA-NPC) [15], while additional randomized controlled clinical trials to determine the role of systemic chemotherapy in NPC during the intensity modulation radiotherapy (IMRT) era are still underway
A prior study showed that changing from adjuvant cisplatin and 5fluorouracil to induction cisplatin and capecitabine caused a favorable trend of increasing efficacy with
Summary
Due to improvements in imaging and radiological techniques as well as the use of chemotherapy, distant metastasis has become the predominant mode of treatment failure in patients with locally advanced nasopharyngeal carcinoma (LA-NPC). The development of high-resolution imaging and radiological techniques has increased the local control rate of NPC up to 95% [2], leaving distant metastasis as the major cause of treatment failure. To address this issue, a combined regimen of chemotherapy and radiotherapy has been recommended as the standard treatment strategy for locally advanced NPC (LA-NPC) [3]. Ma J et al recently demonstrated that the introduction of cisplatin, fluorouracil, and docetaxel (TPF) induction chemotherapy to concurrent chemotherapy could significantly improve the PFS of patients with LA-NPC [15], while additional randomized controlled clinical trials to determine the role of systemic chemotherapy in NPC during the intensity modulation radiotherapy (IMRT) era are still underway
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