Journal of Cancer Research and Clinical Oncology

, Volume 138, Issue 10, pp 1717–1725 | Cite as

Comparison of five cisplatin-based regimens frequently used as the first-line protocols in metastatic nasopharyngeal carcinoma

  • Ying Jin
  • Xiu-Yu Cai
  • Yan-Xia Shi
  • Xi-Ya Xia
  • Yu-Chen Cai
  • Ye Cao
  • Wei-Dong Zhang
  • Wei-Han HuEmail author
  • Wen-Qi JiangEmail author
Original Paper


Background and objective

No randomized trial has been reported comparing different chemotherapy regimens on disseminated nasopharyngeal carcinoma (NPC). This study aims to compare five cisplatin-based regimens including cisplatin + 5-fluororacil (PF), paclitaxel + cisplatin (TP), gemcitabine + cisplain (GP), paclitaxel + cisplatin + 5-fluororacil (TPF), and bleomycin + cisplatin + 5-fluororacil (BPF) regimen most frequently used as the first-line protocols for metastatic NPC retrospectively.


Eight hundred and twenty-two patients with metastatic NPC were divided into five groups according to the regimen they received. Then, their response rate, toxicity, and long-term survival outcome as well as the prognostic factors were analyzed.


The higher response rates in GP and TPF regimens comparing to PF regimen were achieved (Χ 2 = 4.57, P = 0.033; Χ 2 = 7.04, P = 0.008), as well as in TPF regimen comparing to TP regimen (Χ 2 = 5.579, P = 0.018). The occurrence rate of the major III–IV grade toxicity was significantly different between the five groups. However, no statistically significant difference was observed in progression-free survival (PFS; P = 0.247) and overall survival (P = 0.127) among the five groups. Cox multivariate analysis identified the following independent prognostic factors: liver metastases, plasma Epstein Barr Virus (EBV)-DNA level, cycles of chemotherapy, and second-line chemotherapy.


PF, TP, and GP are all effective regimens as the first-line chemotherapy for metastatic NPC, which can be well tolerated. Over four cycles of chemotherapy are recommended under no contraindication. Patients should transfer to the second-line regimen after the treatment failure of the first-line chemotherapy.


Comparison of five cisplatin-based regimens Metastatic nasopharyngeal carcinoma Overall survival Palliative chemotherapy Progression-free survival 



This work was supported by the National—Eleventh Five Technology Major Project [2008ZX09312-002]; and the Research Award Fund for Outstanding Young Researchers in Sun Yat-sen Cancer Center. Sponsors of the study supported the fees to data collecting and will support the publication of the paper.

Conflict of interest

All authors state that they have no conflicts of interest.


  1. An X, Wang FH, Ding PR et al (2011) Plasma Epstein-Barr virus DNA level strongly predicts survival in metastatic/recurrent nasopharyngeal carcinoma treated with palliative chemotherapy. Cancer 117:3750–3757Google Scholar
  2. Au E, Ang PT (1994) A phase II trial of 5-fluorouracil and cisplatinum in recurrent or metastatic nasopharyngeal carcinoma. Ann Oncol 5(1):87–89PubMedGoogle Scholar
  3. Azli N, Fandi A, Bachouchi M et al (1995) Final report of a phase II study of chemotherapy with bleomycin, epirubicin, and cisplatin for locally advanced and metastatic/recurrent undifferentiated carcinoma of the nasopharyngeal type. Cancer J Sci Am 1(3):222–229PubMedGoogle Scholar
  4. Bensouda Y, Kaikani W, Ahbeddou N et al (2011) Treatment for metastatic nasopharyngeal carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis 128(2):79–85PubMedCrossRefGoogle Scholar
  5. Boussen H, Cvitkovic E, Wendling JL et al (1991) Chemotherapy of metastatic and/or recurrent undifferentiated nasopharyngeal carcinoma with cisplatin, bleomycin, and fluorouracil. J Clin Oncol 9(9):1675–1681PubMedGoogle Scholar
  6. Chang ET, Adami HO (2006) The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev 15(10):1765–1777PubMedCrossRefGoogle Scholar
  7. Chiesa F, De Paoli F (2001) Distant metastases from nasopharyngeal cancer. ORL J Otorhinolaryngol Relat Spec 63(4):214–216PubMedCrossRefGoogle Scholar
  8. Chua DT, Wei WI, Wong MP, Sham JS, Nicholls J, Au GK (2008) Phase II study of gefitinib for the treatment of recurrent and metastatic nasopharyngeal carcinoma. Head Neck 30(7):863–867Google Scholar
  9. Ciuleanu TE, Fountzilas G, Ciuleanu E, Plataniotis M, Todor N, Ghilezan N (2004) Paclitaxel and carboplatin in relapsed or metastatic nasopharyngeal carcinoma: a multicenter phase II study. J BUON 9(2):161–165PubMedGoogle Scholar
  10. Ciuleanu E, Irimie A, Ciuleanu TE, Popita V, Todor N, Ghilezan N (2008) Capecitabine as salvage treatment in relapsed nasopharyngeal carcinoma: a phase II study. J BUON 13(1):37–42Google Scholar
  11. Foo KF, Tan EH, Leong SS et al (2002) Gemcitabine in metastatic nasopharyngeal carcinoma of the undifferentiated type. Ann Oncol 13(1):150–156PubMedCrossRefGoogle Scholar
  12. He XY, Hu CS, Ying HM, Wu YR, Zhu GP, Liu TF (2010) Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 267(5):773–778PubMedCrossRefGoogle Scholar
  13. Kam MK, Leung SF, Zee B et al (2007) Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol 25(31):4873–4879Google Scholar
  14. Lee AW, Poon YF, Foo W et al (1992) Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated during 1976–1985: overall survival and patterns of failure. Int J Radiat Oncol Biol Phys 23(2):261–270PubMedCrossRefGoogle Scholar
  15. Lin JT, Lai GM, Chang TH et al (2012) Chemotherapy with modified docetaxel, cisplatin, and 5-Fluorouracil in patients with metastatic head and neck cancer. Adv Ther 29(1):71–77PubMedCrossRefGoogle Scholar
  16. Liu MT, Hsieh CY, Chang TH, Lin JP, Huang CC, Wang AY (2003) Prognostic factors affecting the outcome of nasopharyngeal carcinoma. Jpn J Clin Oncol 33(10):501–508PubMedCrossRefGoogle Scholar
  17. Ma BB, Chan AT (2005) Recent perspectives in the role of chemotherapy in the management of advanced nasopharyngeal carcinoma. Cancer 103(1):22–31Google Scholar
  18. Ma BB, Tannock IF, Pond GR, Edmonds MR, Siu LL (2002) Chemotherapy with gemcitabine-containing regimens for locally recurrent or metastatic nasopharyngeal carcinoma. Cancer 95(12):2516–2523Google Scholar
  19. Ngan RK, Yiu HH, Lau WH et al (2002) Combination gemcitabine and cisplatin chemotherapy for metastatic or recurrent nasopharyngeal carcinoma: report of a phase II study. Ann Oncol 13(8):1252–1258PubMedCrossRefGoogle Scholar
  20. Ngeow J, Lim WT, Leong SS et al (2011) Docetaxel is effective in heavily pretreated patients with disseminated nasopharyngeal carcinoma. Ann Oncol 22(3):718–722PubMedCrossRefGoogle Scholar
  21. Ong YK, Heng DM, Chung B et al (2003) Design of a prognostic index score for metastatic nasopharyngeal carcinoma. Eur J Cancer 39(11):1535–1541PubMedCrossRefGoogle Scholar
  22. Sakata K, Aoki Y, Karasawa K et al (1994) Wide variation of probability of local failure and distant metastasis among various stages of patients with nasopharyngeal carcinoma. Strahlenther Onkol 170(4):218–224PubMedGoogle Scholar
  23. Schwarz LR (1996) Elimination of dose limiting toxicities of cisplatin, 5-fluorouracil, and leucovorin using a weekly 24-hour infusion schedule for the treatment of patients with nasopharyngeal carcinoma. Cancer 78(3):566–567Google Scholar
  24. Su WC, Chen TY, Kao RH, Tsao CJ (1993) Chemotherapy with cisplatin and continuous infusion of 5-fluorouracil and bleomycin for recurrent and metastatic nasopharyngeal carcinoma in Taiwan. Oncology 50(4):205–208PubMedCrossRefGoogle Scholar
  25. Tao Y, Bidault F, Bosq J, Bourhis J (2008) Distant metastasis of undifferentiated carcinoma of nasopharyngeal type. Onkologie 31(11):574–575PubMedCrossRefGoogle Scholar
  26. Wang TL, Tan YO (1991) Cisplatin and 5-fluorouracil continuous infusion for metastatic nasopharyngeal carcinoma. Ann Acad Med Singap 20(5):601–603PubMedGoogle Scholar
  27. Yu MC, Yuan JM (2002) Epidemiology of nasopharyngeal carcinoma. Semin Cancer Biol 12(6):421–429PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ying Jin
    • 1
    • 3
  • Xiu-Yu Cai
    • 3
  • Yan-Xia Shi
    • 3
  • Xi-Ya Xia
    • 3
  • Yu-Chen Cai
    • 2
  • Ye Cao
    • 4
  • Wei-Dong Zhang
    • 5
  • Wei-Han Hu
    • 6
    Email author
  • Wen-Qi Jiang
    • 3
    Email author
  1. 1.Department of Medical OncologyZhejiang Cancer HospitalHangzhouChina
  2. 2.State Key Laboratory of Oncology in South ChinaGuangzhouChina
  3. 3.Department of Medical OncologySun Yat-Sen University Cancer CenterGuangzhouChina
  4. 4.Department of Good Clinical PracticeSun Yat-Sen University Cancer CenterGuangzhouChina
  5. 5.Department of RadiologySun Yat-Sen University Cancer CenterGuangzhouChina
  6. 6.Department of RadiotherapySun Yat-Sen University Cancer CenterGuangzhouChina

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