# Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma

Source: https://onco.cc/key-papers/paper-zhang-gemcitabine-cisplatin-vs-fluorouracil-cisplatin-rm-npc-lancet-2016/  
OnCo record `paper-zhang-gemcitabine-cisplatin-vs-fluorouracil-cisplatin-rm-npc-lancet-2016` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The first phase 3 trial in metastatic nasopharyngeal cancer found gemcitabine with cisplatin held the disease back for longer than the older fluorouracil-cisplatin combination, and it became the chemotherapy backbone to which immunotherapy was later added.

## Summary

Chinese multicentre open-label randomised phase 3 trial of 362 patients with recurrent or metastatic nasopharyngeal carcinoma assigned to gemcitabine plus cisplatin or fluorouracil plus cisplatin for up to six cycles.

Median progression-free survival was 7.0 months with gemcitabine-cisplatin against 5.6 months (hazard ratio 0.55), with a higher response rate and a later overall survival advantage; toxicity profiles differed (myelosuppression versus mucositis).

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: The Lancet
- Year: 2016
- DOI: 10.1016/S0140-6736(16)31388-5
- Authors: Zhang L, Huang Y, Hong S, et al.
- Findings: Median progression-free survival 7.0 months with gemcitabine-cisplatin versus 5.6 months with fluorouracil-cisplatin; hazard ratio 0.55.; Higher objective response rate with gemcitabine-cisplatin.
- What it means: Gemcitabine and cisplatin is the first-line chemotherapy for recurrent or metastatic nasopharyngeal carcinoma and the backbone of the toripalimab, camrelizumab and tislelizumab combinations.
- Caveats: Open-label; conducted entirely in China.; Median survival remained under two years with chemotherapy alone.

## Sources

- Lancet 2016: https://doi.org/10.1016/S0140-6736(16)31388-5
- PubMed: https://pubmed.ncbi.nlm.nih.gov/27567279/

## Connected records

- cancers: [Recurrent and metastatic nasopharyngeal carcinoma](https://onco.cc/cancers/recurrent-metastatic-nasopharyngeal-carcinoma/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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