Experience with combination of cetuximab plus intensity-modulated radiotherapy with or without chemotherapy for locoregionally advanced nasopharyngeal carcinoma
- 659 Downloads
To evaluate the safety and efficacy of cetuximab plus intensity-modulated radiotherapy (IMRT) with or without chemotherapy for locoregionally advanced nasopharyngeal carcinoma (NPC).
From June 2007 to December 2010, 33 patients with stage II (12 %), III (33 %), IVA (33 %), and IVB (21 %) NPC were treated at our hospital. Cetuximab was administered at an initial dose of 400 mg/m2 followed by weekly doses of 250 mg/m2. All patients completed IMRT, and a total dose of 66–70.4, 66, 60, and 54 Gy were given to the gross tumor volume, positive neck nodes, high-risk clinical target volume, and low-risk clinical target volume, respectively. Most patients (90.9 %) received platinum-based neoadjuvant, concurrent, or adjuvant chemotherapy. The efficacy and safety were evaluated retrospectively.
With a median follow-up of 40.0 months, the 3-year progression-free survival (PFS), distant metastasis-free survival, and overall survival were 70.5 % (95 % CI 54.0–87.0 %), 83.6 % (95 % CI 70.3–96.9 %), and 90.9 % (95 % CI 81.1–100.0 %), respectively. Majority (75.8 %) of patients received ≥7 cycles of cetuximab (median 7 cycles, range 2–14 cycles). Patients who received ≥7 cycles of cetuximab showed a better 3-year PFS than those receiving <7 cycles (79.1 vs. 31.2 %, p = 0.050). During cetuximab + IMRT, stomatitis was the most common acute treatment toxicity, 23 (69.7 %) and 5 (15.2 %) patients with grade 3 and grade 4 stomatitis, respectively. Temporal lobe necrosis was observed in 7 patients.
Cetuximab plus IMRT with or without chemotherapy for locoregionally advanced NPC is effective and tolerated. Further investigations are warranted.
KeywordsNasopharyngeal carcinoma Cetuximab Intensity-modulated radiotherapy Clinical outcome
Conflict of interest
- Ang KK, Zhang QE, Rosenthal DI et al (2011) Phase III trial (RTOG 0522) of concurrent accelerated radiation plus cisplatin with or without cetuximab (Cet) for locally advanced HNSCC. J Clin Oncol 29 (suppl; abstr 5500)Google Scholar
- Bentzen SM, Atasoy BM, Daley FM et al (2005) Epidermal growth factor receptor expression in pretreatment biopsies from head and neck squamous cell carcinoma as a predictive factor for a benefit from accelerated radiation therapy in a randomized controlled trial. J Clin Oncol 23:5560–5567PubMedCrossRefGoogle Scholar
- Lefebvre J, Pointreau Y, Rolland F et al (2011) Sequential chemoradiotherapy (SCRT) for larynx preservation (LP): results of the randomized phase II TREMPLIN study. J Clin Oncol 29 (suppl; abstr 5501)Google Scholar