ADJUVANT CHEMOTHERAPY AFTER CHEMORADIOTHERAPY IMPROVES SURVIVAL OF NASOPHARYNGEAL CARCINOMA

In an individual patient-data meta-analysis reported in the Journal of Clinical Oncology, Ribassin-Majed et al in the Meta-analysis of Chemotherapy in Nasopharyngeal Collaborative Group found that the addition of adjuvant chemotherapy to chemoradiotherapy was associated with the greatest overall survival benefit among options for treating locally advanced nasopharyngeal carcinoma.

Study Details

The meta-analysis included 5,144 patients from 20 randomized trials of radiotherapy with or without chemotherapy in nonmetastatic nasopharyngeal carcinoma. Treatments were grouped into seven categories: radiotherapy, induction chemotherapy followed by radiotherapy (IC-RT), radiotherapy followed by adjuvant chemotherapy (RT-AC), induction chemotherapy followed by radiotherapy followed by adjuvant chemotherapy (IC-RT-AC), concomitant chemoradiotherapy, induction chemotherapy followed by chemoradiotherapy (IC-CRT), and chemoradiotherapy followed by adjuvant chemotherapy (CRT-AC).

Key Findings

Compared with radiotherapy alone, the three treatments with the greatest overall survival benefit were CRT-AC (hazard ratio [HR] = 0.65 [95% confidence interval (CI) = 0.56–0.75]), chemoradiotherapy (HR = 0.77, 95% CI = 0.64–0.92), and IC-CRT (HR = 0.81, 95% CI = 0.63–1.04). Compared with chemoradiotherapy, hazard ratios for CRT-AC were 0.85 (95% CI = 0.68–1.05) for overall survival, 0.81 (95% CI = 0.66–0.98) for progression-free survival, 0.70 (95% CI = 0.48–1.02) for locoregional control, and 0.87 (95% CI = 0.61–1.25) for distant control. Compared with radiotherapy alone, IC-CRT ranked second for progression-free survival and first for disease control.

Chemoradiotherapy did not rank first in any endpoint. Compared with IC-CRT, hazard ratios for chemoradiotherapy were 0.95 (95% CI = 0.72–1.25) for overall survival, 1.13 (95% CI = 0.88–1.46) for progression-free survival, 1.05 (95% CI = 0.70–1.59) for locoregional control, and 1.55 (95% CI = 0.94–2.56) for disease control. Regimens including more chemotherapy were associated with increased acute toxicity.

The investigators concluded: “The addition of AC to CRT achieved the highest survival benefit and consistent improvement for all end points. The addition of IC to CRT achieved the highest effect on [disease control].”

The study was supported by grants from the French Ministry of Health and Ligue Nationale Contre le Cancer.