Alternative Drug Combo Option in Nasopharyngeal Carcinoma?

Top line:

Adjuvant cisplatin-gemcitabine significantly improves progression-free survival (PFS) over standard cisplatin-fluorouracil in N2-3 nasopharyngeal carcinoma.

methodology:

• The study included patients aged 18-65 with previously untreated non-keratinizing stage T1-4 N2-3 M0 nasopharyngeal carcinoma who were treated in a randomized trial at four cancer centers in China. It was

• Four weeks after prior chemoradiation, 120 patients received chemoradiation. Gemcitabine (1g/m² intravenously on days 1 and 8) and Cisplatin (80mg/m² Intravenous on day 1, every 3 weeks for 3 cycles.

• 120 more patients were admitted Fluorouracil (4g/m² continuous IV infusion) and cisplatin (80 mg/m2)² Intravenous on day 1, every 4 weeks for 3 cycles.

• Nearly 62% of patients in the cisplatin-gemcitabine group completed all three cycles, and 77% in the cisplatin-fluorouracil group. Median follow-up was 40 months.

remove:

• Overall, 3-year PFS was 83.9% (19 disease progression, 11 deaths) in the cisplatin-gemcitabine group compared with 71.5% (34 disease progression, 7 deaths) in the cisplatin-fluorouracil group. (hazard ratio 0.54, hazard ratio 0.54). P. = .023).

• The 3-year cumulative incidence of locoregional recurrence was 2.6% with cisplatin-gemcitabine versus 13.6% with cisplatin-fluorouracil. The 3-year cumulative incidence of distant metastasis was 10.9% vs. 22.3%.

• The most common acute grade 3+ adverse event was leukopenia (52% with cisplatin-gemcitabine and 29% with cisplatin-fluorouracil). Neutropenia (32% vs 16%), mucositis (23% vs 28%).

• hearing loss It was the most common grade 3+ late adverse event (5% vs. 9% for cisplatin-gemcitabine). One treatment-related death occurred in the cisplatin-gemcitabine group. cause of death septic shock.

in fact:

• “These results support the potential role of adjuvant therapy with cisplatin-gemcitabine chemotherapy in the treatment of nasopharyngeal carcinoma.” The study authors concluded.

Study details:

• The study was led by Li-Ting Liu, M.D., Ph.D., Sun Yat-sen University Cancer Center in Guangzhou, published June 5th Lancet Oncology.

Limitations:

• This study was conducted in an endemic area. It is unclear whether this result holds true elsewhere.

• The effect of the adjuvant cisplatin-gemcitabine on early overall survival was not significant. Longer follow-up is needed.

• No baseline PET/CT was required. As a result, potential distant metastasis may be missed.

• Further studies in more globally diverse populations are needed to confirm the results.

Disclosure:

• This research was funded by China National Key Research and Development Program, China National Natural Science Foundation and others.

• Investigators reported no relevant financial relationships.

M. Alexander Otto is a Physician Assistant with a Master of Medicine and Journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news organizations before joining Medscape. Alex is an MIT Knight He is also a Science Journalism Fellow. Email: [email protected].

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