# Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma

Source: https://onco.cc/key-papers/paper-zhang-gemcitabine-cisplatin-induction-nasopharyngeal-nejm-2019/  
OnCo record `paper-zhang-gemcitabine-cisplatin-induction-nasopharyngeal-nejm-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Three cycles of gemcitabine and cisplatin before chemoradiotherapy cut recurrences and improved survival in locoregionally advanced nasopharyngeal cancer, making induction chemotherapy the standard in endemic regions.

## Summary

Chinese multicentre randomised phase 3 trial of 480 patients with locoregionally advanced nasopharyngeal carcinoma (stage III to IVB, excluding T3-4N0 and T3N1) comparing three cycles of induction gemcitabine and cisplatin followed by concurrent cisplatin chemoradiotherapy with chemoradiotherapy alone.

Three-year recurrence-free survival was 85.3 percent with induction against 76.5 percent, and overall survival 94.6 percent against 90.3 percent, with the largest reduction in distant metastases; acute toxicity was higher during induction but late toxicity was similar.

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: New England Journal of Medicine
- Year: 2019
- DOI: 10.1056/NEJMoa1905287
- Authors: Zhang Y, Chen L, Hu GQ, et al.
- Findings: Three-year recurrence-free survival 85.3 percent with induction gemcitabine-cisplatin versus 76.5 percent with chemoradiotherapy alone.; Three-year overall survival 94.6 percent versus 90.3 percent; fewer distant metastases.
- What it means: Induction gemcitabine and cisplatin followed by chemoradiotherapy is the standard for locoregionally advanced nasopharyngeal carcinoma in endemic regions and in guidelines internationally.
- Caveats: Conducted in an endemic Chinese population with non-keratinising EBV-related tumours; applicability to non-endemic disease is assumed.; Excluded the lower-risk N0 to N1 subgroups.

## Sources

- N Engl J Med 2019: https://doi.org/10.1056/NEJMoa1905287
- PubMed: https://pubmed.ncbi.nlm.nih.gov/31150573/

## Connected records

- cancers: [Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA)](https://onco.cc/cancers/locoregionally-advanced-nasopharyngeal-carcinoma/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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