Paclitaxel, cisplatin, and capecitabine (TPC) is more effective than cisplatin plus fluorouracil (PF) as induction for patients with locoregionally advanced nasopharyngeal carcinoma, according to researchers.
In a phase 3 study, TPC improved failure-free survival, distant metastasis-free survival, and locoregional relapse-free survival. TPC did not improve overall survival. These results were published in JAMA Oncology.
This phase 3 study (ClinicalTrials.gov Identifier: NCT02940925) enrolled 238 patients with stage IVA to IVB nasopharyngeal carcinoma. There were 118 patients randomly assigned to TPC and 120 to PF as induction. Patients went on to receive concurrent chemoradiotherapy (CRT), with 106 patients in the TPC group and 103 in the PF group completing CRT.
The median age at baseline was 45.5 years in the TPC group and 46 years in the PF group. Most patients were men (75.4% and 81.7%, respectively) and had T4 tumors (66.1% and 68.3%, respectively).
The median follow-up was 48.4 months. The overall response rate to induction was 88.1% in the TPC group and 80.0% in the PF group. The overall response rate to the whole treatment was 100% and 95.8%, respectively.
The 3-year failure-free survival rate was 83.5% in the TPC group and 68.9% in the PF group (hazard ratio [HR], 0.47; 95% CI, 0.28-0.79; P =.004).
The 3-year distant metastasis-free survival rate was 91.4% in the TPC group and 80.4% in the PF group (HR, 0.49; 95% CI, 0.24-0.98; P =.04). The 3-year rate of locoregional relapse-free survival was 93.8% and 87.4%, respectively (HR, 0.40; 95% CI, 0.18-0.93; P =.03).
The 3-year overall survival rate was 94.7% in the TPC group and 88.9% in the PF group (HR, 0.45; 95% CI, 0.17-1.18; P =.1).
Grade 3-4 acute adverse events (AEs) occurred in 57.6% of patients in the TPC group and 65.8% of patients in the PF group. The most frequent grade 3-4 AEs were mucositis, nausea, vomiting, and neutropenia. One patient in the PF group died from a treatment-related AE (acute renal failure).
Based on these results, the researchers concluded that TPC can improve efficacy outcomes without increasing toxicity.
Li W-Z, Lv X, Hu D, et al. Effect of induction chemotherapy with paclitaxel, cisplatin, and capecitabine vs cisplatin and fluorouracil on failure-free survival for patients with stage IVA to IVB nasopharyngeal carcinoma: A multicenter phase 3 randomized clinical trial. JAMA Oncol. Published online March 24, 2022. doi:10.1001/jamaoncol.2022.0122