Comparison of five cisplatin-based regimens frequently used as the first-line protocols in metastatic nasopharyngeal carcinoma
- 1.5k Downloads
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.
KeywordsComparison 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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