Chemoradiotherapy is the standard of care for patients with nasopharyngeal carcinoma. Despite this treatment, however, the disease will ultimately be fatal in approximately 70% of patients. Now, data from a large-cohort, open-label phase III randomized controlled trial demonstrate that the addition of induction chemotherapy to chemoradiotherapy leads to improved survival outcomes.
A total of 480 patients with locoregionally advanced nasopharyngeal carcinoma were randomized (1:1) to receive chemoradiotherapy with, or without, 3 prior cycles of gemcitabine plus cisplatin induction chemotherapy. Recurrence-free survival (RFS) was the primary end point.
Virtually all patients (94.6%) responded to induction chemotherapy. After a median follow-up duration of 42.7 months, patients in the induction chemotherapy group had significantly improved 3-year RFS (85.3% versus 76.5%, hazard ratio (HR) for disease recurrence or death 0.51, 95% CI 0.34–0.77; P = 0.001). Patients receiving induction chemotherapy also had improved 3-year overall survival (94.6% versus 90.3%, respectively, HR 0.43, 95% CI 0.24–0.77). Interestingly, however, no significant differences in 3-year locoregional RFS emerged from the analysis (91.8% versus 91.0%, HR for locoregional recurrence or death 0.77, 95% CI 0.42–1.41).
Patients receiving induction chemotherapy had an increased risk of adverse events: acute grade 3–4 adverse events occurred in 75.7% of patients versus 55.7% of those receiving chemoradiotherapy only, although the risk of late-onset serious adverse events was similar (9.2% versus 11.4%).
These data demonstrate that induction chemotherapy improves the efficacy of chemoradiotherapy, albeit with a substantial increase in the risk of adverse events. Longer follow-up monitoring will be required to determine the balance between tolerability and the risk of mortality associated with receiving chemoradiotherapy only.
Zhang, Y. et al. Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa1905287 (2019)
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Sidaway, P. Induction chemotherapy improves efficacy. Nat Rev Clin Oncol 16, 528 (2019). https://doi.org/10.1038/s41571-019-0242-0