For high risk nasopharyngeal carcinoma (NPC), chemoradiation with either neoadjuvant or adjuvant chemotherapy is the preferred approach to treatment. And while both have been compared to CRT alone, there is more limited data comparing induction chemo and adjuvant chemo. In this randomized, phase 3 trial, 266 patients with locally advanced NPC were randomized to receive either induction docetaxel, cisplatin, and fluorouracil followed by CRT or CRT followed by adjuvant cisplatin and fluorouracil. At 3 years, there was no difference in the rate of PFS between induction and adjuvant chemo (79% v 74.5%). Induction chemo had worse hematologic effects, but adverse effects during CRT were less than in the adjuvant CRT arm. So, this suggest similar outcomes regardless of the sequencing of therapy, though it doesn’t directly address the use of the gemcitabine plus cisplatin induction regimen. | He, Radiother Oncol 2026
