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Concurrent chemoradiotherapy combined with nimotuzumab in stage III–IVa nasopharyngeal carcinoma: a retrospective analysis

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The efficacy and safety of nimotuzumab (NTZ) added to concurrent chemoradiotherapy (CCRT) were investigated in patients with stage III–IVa nasopharyngeal carcinoma (NPC).

Methods

Patients with stage III–IVa NPC treated with CCRT, with or without NTZ, were screened between January 2015 and December 2017. We compared patients’ overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) between different therapeutic regimens. Propensity score matching (PSM) was applied to reduce the selection bias. Nomogram models were developed to predict the survival of CCRT with or without NTZ.

Results

Four hundred and twenty-six patients were included after PSM, with 213 patients in each regimen. Compared with NPC patients receiving CCRT alone, patients who received NTZ plus CCRT treatment had significantly better OS (5 year OS, 76.1 vs. 72.3%, P = 0.004), PFS (5 year PFS, 73.2 vs. 69.0%, P = 0.002), and LRFS (5 year LRFS, 73.2 vs. 69.0%, P = 0.028). A multivariate Cox regression analysis demonstrated that, compared with receiving CCRT alone, NTZ plus CCRT was an independently positive factor for OS, PFS, and LRFS. No significant difference was observed in the major toxicities between the two treatments (all P > 0.05). In addition, the nomogram presented good accuracy for predicting the prognosis of NPC patients.

Conclusion

CCRT combined with NTZ presented favorable clinical outcomes for stage III–IVa NPC patients with good tolerance and similar toxicity compared to CCRT alone. A prospective, randomized clinical trial is essential to validate the current findings.

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Data availability

The datasets for the current study are available on request to the corresponding authors.

Abbreviations

CCRT:

Concurrent chemoradiotherapy

NTZ:

Nimotuzumab

NPC:

Nasopharyngeal carcinoma

OS:

Overall survival

PFS:

Progression-free survival

LRFS:

Locoregional recurrence-free survival

DMFS:

Distant metastasis-free survival

PSM:

Propensity score matching

CSCO:

Chinese Society of Clinical Oncology

IMRT:

Intensity-modulated radiotherapy

EGFR:

Epidermal growth factor receptor

CTX:

Cetuximab

CT:

Computed tomography

GTV:

Gross tumor volume

GTVnx:

Gross tumor volume of nasopharynx

GTVnd:

Gross tumor volume of cervical lymph node

CTV:

Clinical tumor volume

BMI:

Body mass index

LDH:

Lactate dehydrogenase

CRP:

C reactive protein

C-index:

Concordance index

PFS:

Progression-free survival

IC:

Induction chemotherapy

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Acknowledgements

We are grateful to our patients and staff involved in the patient care for making this work possible. We kindly thank the editor and reviewers for their careful review and valuable comments, which have helped significantly improve the manuscript.

Funding

This work was supported by grants from the National Natural Science Foundation of China (grant numbers 81872375 and 82172863) and the Natural Science Foundation of Guangdong Province (grant numbers 2021A1515010118).

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Author notes

  1. Zhuochen Cai, Dongni Chen and Wenze Qiu contributed equally.

Authors and Affiliations

  1. Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, People’s Republic of China

    Zhuochen Cai, Chixiong Liang, Yingying Huang, Jiayu Zhou, Zejiang Zhan, Yanqun Xiang, Xiang Guo & Xing Lv

  2. Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510089, Guangdong, People’s Republic of China

    Dongni Chen

  3. Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, No 78, Hengzhigang Road, Yuexiu District, Guangzhou, 510095, Guangdong, People’s Republic of China

    Wenze Qiu

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Contributions

ZC developed the study concepts and design. CL and YH participated in the data acquisition. DC and WQ participated in the data analysis and interpretation. ZC, JZ and ZZ participated in the manuscript writing and editing. YX, XG and XL participated in the manuscript review. All authors contributed to the article and approved the submitted version.

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Correspondence to Xiang Guo or Xing Lv.

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This retrospective study was approved by the Clinical Research Committee of Sun Yat-sen University Cancer Center (B2021-366-01).

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Cai, Z., Chen, D., Qiu, W. et al. Concurrent chemoradiotherapy combined with nimotuzumab in stage III–IVa nasopharyngeal carcinoma: a retrospective analysis. J Cancer Res Clin Oncol 149, 2327–2344 (2023). https://doi.org/10.1007/s00432-022-04355-w

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