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The safety and efficacy of gemcitabine and cisplatin (GP)‐based induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a meta‐analysis

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Abstract

Objective

To assess the safety and efficacy of gemcitabine and cisplatin (GP)‐based induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).

Methods

We systematically searched the PubMed, Web of Science, Embase, and Cochrane Library databases. The endpoints included overall survival (OS), progression-free survival (PFS), distant failure-free survival (DMFS), locoregional failure-free survival (LRFFS) and treatment-related adverse events (AEs).

Results

A total of seven studies were included in this meta-analysis. When GP-based IC was compared with double-drug-based or triple-drug-based IC, there were no significant differences in OS (HR 0.64, P = 0.08), PFS (HR 0.71, P = 0.09), DMFS (HR 0.87, P = 0.49) or LRFFS (HR 0.88, P = 0.66). Furthermore, subgroup analysis revealed that GP IC led to an improvement in OS compared with triple-drug-based IC (P < 0.0001). Regarding safety, compared to triple-drug-based IC, GP-based IC was related to a decreased risk of leucopenia (P = 0.007) and neutropenia (P = 0.02) but was associated with an increased risk of thrombocytopenia (P = 0.01). Compared to double-drug-based IC, the prevalence of grade 3 or above thrombocytopenia was higher in the GP group (P = 0.007). No significant difference in the incidence of other AEs was observed.

Conclusion

Based on efficacy and safety, our meta-analysis demonstrated that, compared to double-drug-based or triple-drug-based IC, IC with a GP regimen does not appear to improve OS, PFS, DMFS or LRFFS and mainly led to an increased risk of grade3/4 thrombocytopenia. Notably, our subgroup analysis data show that GP-based IC may bring improved trends in OS as compared to triple-drug-based IC. For the optimal IC regimen has not been established, which IC regimen will benefit most LA-NPC patients should be further explored.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yu Zhong District, Chongqing, 400016, People’s Republic of China

    Min Tang & Ju Zhang

  2. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yu Zhong District, Chongqing, 400016, People’s Republic of China

    Zhongxiong Jia

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  1. Min Tang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by, MT, ZJ and JZ. The first draft of the manuscript was written by MT and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ju Zhang.

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Tang, M., Jia, Z. & Zhang, J. The safety and efficacy of gemcitabine and cisplatin (GP)‐based induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a meta‐analysis. Eur Arch Otorhinolaryngol 279, 1561–1572 (2022). https://doi.org/10.1007/s00405-021-06940-0

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  • DOI: https://doi.org/10.1007/s00405-021-06940-0

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