Nasopharyngeal carcinoma is a rather rare tumor entity in Europe, which is often only detected at an advanced stage. With combined radiochemotherapy, the chances of cure are good in non-metastatic patients. But does this treatment also help with the occurrence of distant metastases?
Nasopharyngeal carcinoma is one of the rather rare tumor types in Europe and is usually diagnosed at an advanced stage. Environmental factors, genetic basis and a viral genesis could be the cause. The diagnosis is made histologically by biopsy. At initial diagnosis, many patients already have advanced unresectable disease with locoregional metastasis. The role of locoregional radiotherapy in those with primary metastatic nasopharyngeal carcinoma (mNPC) has now been investigated using a randomized, open-label phase III trial.
Included were 126 patients with primary stage IVc mNPC. The main inclusion criteria were CR or PR assessed by imaging study after three cycles of chemotherapy according to RECST v1.1. Sufferers received either chemotherapy, or chemotherapy combined with radiation therapy, in a 1:1 ratio. Chemotherapy regimens were fluorouracil at 5 g/m2 over 120 h hours and cisplatin at 100 mg/m2 on day 1 once every 3 weeks for a maximum of six cycles. The primary endpoint was overall survival (OS).
Significant superiority demonstrated
The study had to be stopped early because of a clear difference between the two study arms in favor of the combined therapy. The median follow-up time was 25.2 months. Median OS was 40.2 months (95% CI 25.7-54.7) in the chemotherapy plus radiotherapy group and 24.5 months (95% CI 15.3-33.7) in the chemotherapy alone group (HR 0.45 95% CI 0.25-0.80; p=0.007). No significant differences were observed between the two treatment groups in terms of hematologic toxicity and gastrointestinal response. The incidence of grade 2-3 skin reaction and grade 3-4 mucositis in chemotherapy plus radiotherapy was significantly higher than in chemotherapy alone groups (p<0.05).
Source: European Society for Medical Oncology (ESMO) 2019
Further reading:
- Chen M, You R, You-Ping L, et al: Chemotherapy plus local-regional radiotherapy versus chemotherapy alone in primary metastatic nasopharyngeal carcinoma: A randomized, open-label, phase III trial. Annals of Oncology 2019; DOI: https://doi.org/10.1093/annonc/mdz252
InFo ONCOLOGY & HEMATOLOGY 2019; 7(6): 29 (published 12/7/19, ahead of print).
