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Does Neoadjuvant/Induction Chemotherapy Benefit High-Risk, Locally Advanced Nasopharyngeal Carcinoma?
Nasopharyngeal carcinoma (NPC) is a unique subset of head and neck cancers strongly associated with Epstein-Barr virus infection and prone to distant metastasis. While concurrent chemoradiotherapy (CRT), with or without induction and/or adjuvant systemic therapy, is the standard of care for locoregionally advanced NPC, patients with extensive nodal involvement (N2–3) remain at high risk for systemic failure.
In this multicenter, open-label, phase 3 trial conducted in China, 186 patients with newly diagnosed stage T1–4, N2–3, M0 NPC were randomized to receive either four cycles of neoadjuvant docetaxel (75 mg/m2 on day 1) and cisplatin (37.5 mg/m2 on days 2–3) followed by CRT, or CRT alone.
At a median follow-up of 76.9 months, the addition of neoadjuvant chemotherapy significantly improved 5-year distant metastasis–free survival (91.3% vs. 78.2%; hazard ratio, 0.41) and overall survival (90.3% vs. 82.6%; HR, 0.38). Grade 3–4 acute toxicities were more common in the neoadjuvant group (65% vs. 51%), mainly due to neutropenia (47% vs. 11%), but no differences in late toxicities or long-term quality of life were observed.
Comment
This is the first phase 3 trial focused exclusively on N2–3 NPC. By targeting N2–3 disease, the study enriched for patients most likely to benefit from intensified systemic therapy. Immunotherapy-based approaches, although promising, are often costlier, less accessible, and associated with immune-related toxicities. This trial demonstrates that a cytotoxic regimen using docetaxel and cisplatin — a widely available and relatively cost-effective option — can deliver substantial benefit when used selectively in high-risk patients, and highlights the importance of risk-adapted strategies in NPC management, particularly in resource-constrained settings. This treatment also could be an option for patients who are not fit for a higher cisplatin bolus (75 mg/m2) with gemcitabine and cisplatin induction.
Citation(s)
Author:
Xie W-H et al.
Title:
Four cycles of docetaxel plus cisplatin as neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in stage N2-3 nasopharyngeal carcinoma: Phase 3 multicentre randomised controlled trial.
Source:
BMJ
2025
Apr
15; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Hyunseok Kang, MD, MPH, FACP