Top Line: Is concurrent chemotherapy necessary with radiation following induction chemotherapy for locally advanced nasopharyngeal carcinoma?
The Study: Induction chemotherapy followed by chemoradiation is the preferred treatment for locoregionally advanced nasopharyngeal carcinoma. In this phase 3 non-inferiority trial, 383 patients with stage III (54%) to IVB NPC received induction chemotherapy consisting of 3 cycles of cisplatin, docetaxel, and 5FU. They were then randomized to receive definitive RT alone or concurrent chemoradiation with weekly cisplatin. The trial was designed with a 3-year progression free survival non-inferiority margin of 10%. At the 3 year mark, PFS was deemed non-inferior with RT alone (76.2% v 76.8%). Overall survival, distant metastasis free survival, and locoregional failure free survival were also similar between groups. Acute grade 3-4 toxicity was significantly lower in the RT alone arm (54% v 73%). There were no differences in late toxicity.
TBL: This randomized trial suggests that outcomes with radiation alone are non-inferior to chemoradiation with less toxicity in patients who receive induction chemotherapy for nasopharyngeal carcinoma. | Dai, JAMA Oncol 2024
The Study: Induction chemotherapy followed by chemoradiation is the preferred treatment for locoregionally advanced nasopharyngeal carcinoma. In this phase 3 non-inferiority trial, 383 patients with stage III (54%) to IVB NPC received induction chemotherapy consisting of 3 cycles of cisplatin, docetaxel, and 5FU. They were then randomized to receive definitive RT alone or concurrent chemoradiation with weekly cisplatin. The trial was designed with a 3-year progression free survival non-inferiority margin of 10%. At the 3 year mark, PFS was deemed non-inferior with RT alone (76.2% v 76.8%). Overall survival, distant metastasis free survival, and locoregional failure free survival were also similar between groups. Acute grade 3-4 toxicity was significantly lower in the RT alone arm (54% v 73%). There were no differences in late toxicity.
TBL: This randomized trial suggests that outcomes with radiation alone are non-inferior to chemoradiation with less toxicity in patients who receive induction chemotherapy for nasopharyngeal carcinoma. | Dai, JAMA Oncol 2024