Nasopharyngeal carcinoma (NPC), a malignancy that develops in the upper section of the throat behind the nose, occurs in fewer than one person out of 100,000 worldwide each year. Locally advanced cases of NPC, characterized as either N2 or N3, have metastasized to the cervical lymph nodes located in the neck. Typical treatment for these diagnoses includes chemoradiotherapy, a combination approach including both chemotherapy and radiation therapy. The National Comprehensive Cancer Network (NCCN) guidelines, a set of evidence-based guidelines for cancer treatment, recommend concurrent chemoradiotherapy followed by additional doses of chemotherapy alone as the standard of care for these diagnoses.
A team of researchers set out to optimize the scheduling of chemotherapy and radiation for patients with locally advanced NPC. The results of their assessment, recently published in JAMA Oncology, compare induction-concurrent and concurrent-adjuvant chemoradiotherapy. The induction-concurrent approach consists of three cycles of induction chemotherapy followed by concurrent chemoradiotherapy. The adjuvant-concurrent schedule consisted of concurrent chemoradiotherapy initially, followed by three cycles of adjuvant chemotherapy. Simply, the trial evaluated the efficacy of giving chemotherapy before or after chemoradiotherapy.
The trial enrolled 324 patients with N2 or N3 NPC, and half of the participants received induction-concurrent (induction) chemotherapy, and half received adjuvant-concurrent (adjuvant) chemotherapy. The researchers evaluated three-year progression-free survival (PFS), a key indicator of treatment success, which measures the percentage of patients whose disease had not progressed for three years following treatment.
The analysis unveiled a balanced picture, with similar PFS rates of 73.5% and 70.4% in the induction and adjuvant groups, respectively. Leukopenia, a reduction in the number of white blood cells in the blood, was the most common short-term grade three adverse event, occurring in 33.1% of patients in both groups. Auditory or hearing loss, a late adverse event, was observed in a small percentage of patients (6.2% and 8.5% in the induction and adjuvant groups, respectively). The researchers reported two treatment-related deaths in the induction group and none in the adjuvant group, underscoring the careful balance of benefits and risks in these treatments.
The authors conclude that patients with locally advanced NPC did not significantly benefit from induction-concurrent chemotherapy. This suggests that the current standard of care, which includes concurrent chemoradiotherapy followed by additional doses of chemotherapy alone, is an effective treatment option for these patients.
Sources: JAMA Oncology
