Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma
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.
Overview
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.
- 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.
Induction gemcitabine and cisplatin followed by chemoradiotherapy is the standard for locoregionally advanced nasopharyngeal carcinoma in endemic regions and in guidelines internationally.
- 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.
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