Difference between revisions of "Nasopharyngeal carcinoma"
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<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div> | <div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div> | ||
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+ | <big>Note: this page has regimens specific to nasopharyngeal carcinoma; more general regimens are available on the '''[[head and neck cancer]]''' page.</big> | ||
{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
=Guidelines= | =Guidelines= | ||
==EHNS/ESMO/ESTRO== | ==EHNS/ESMO/ESTRO== | ||
− | *'''2012:''' [ | + | *'''2012:''' Chan et al. [https://www.esmo.org/Guidelines/Head-and-Neck-Cancers/Nasopharyngeal-Cancer Nasopharyngeal cancer: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up] |
=Locally advanced disease, induction= | =Locally advanced disease, induction= | ||
Line 172: | Line 173: | ||
|} | |} | ||
Cisplatin & RT: Cisplatin & '''<u>R</u>'''adiation '''<u>T</u>'''herapy | Cisplatin & RT: Cisplatin & '''<u>R</u>'''adiation '''<u>T</u>'''herapy | ||
− | ===Variant #1, 40 mg/m<sup>2</sup> weekly dosing {{#subobject:b41045|Variant=1}}=== | + | ===Variant #1, 30 mg/m<sup>2</sup> weekly dosing {{#subobject:c0e2e2|Variant=1}}=== |
+ | {| class="wikitable" style="width: 100%; text-align:center;" | ||
+ | !style="width: 25%"|Study | ||
+ | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | !style="width: 25%"|Comparator | ||
+ | !style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
+ | |- | ||
+ | |[https://academic.oup.com/jnci/article/103/23/1761/2516849 Chen et al. 2011a] | ||
+ | |style="background-color:#1a9851"|Phase III (E) | ||
+ | |[[#Radiation_therapy|Radiation therapy]] | ||
+ | | style="background-color:#1a9850" |Superior OS | ||
+ | |- | ||
+ | |} | ||
+ | ====Chemoradiotherapy==== | ||
+ | *[[Cisplatin (Platinol)]] 30 mg/m<sup>2</sup> IV once per week, during radiation | ||
+ | *Concurrent [[External_beam_radiotherapy|radiation therapy]], total dose of 68 to 70 Gy | ||
+ | |||
+ | '''One course''' | ||
+ | ===Variant #2, 40 mg/m<sup>2</sup> weekly dosing {{#subobject:b41045|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
Line 184: | Line 203: | ||
|style="background-color:#d9ef8b"|Might have superior OS (*) | |style="background-color:#d9ef8b"|Might have superior OS (*) | ||
|- | |- | ||
− | |[https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70320-5/fulltext Chen et al. | + | |[https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70320-5/fulltext Chen et al. 2011b] |
|style="background-color:#91cf61"|Non-randomized portion of RCT | |style="background-color:#91cf61"|Non-randomized portion of RCT | ||
|style="background-color:#d3d3d3"| | |style="background-color:#d3d3d3"| | ||
Line 190: | Line 209: | ||
|- | |- | ||
|} | |} | ||
− | ''Note: efficacy for Chan et al. 2002 is based on the 2005 update.'' | + | ''Note: reported efficacy for Chan et al. 2002 is based on the 2005 update.'' |
====Chemoradiotherapy==== | ====Chemoradiotherapy==== | ||
*[[Cisplatin (Platinol)]] 40 mg/m<sup>2</sup> in 1 liter normal saline IV over 2 hours once per day on days 1, 8, 15, 22, 29, 36, 43 | *[[Cisplatin (Platinol)]] 40 mg/m<sup>2</sup> in 1 liter normal saline IV over 2 hours once per day on days 1, 8, 15, 22, 29, 36, 43 | ||
Line 199: | Line 218: | ||
*Chen et al. 2011: [[#Cisplatin_.26_Fluorouracil_2|CF]] versus [[#Observation|no further treatment]] | *Chen et al. 2011: [[#Cisplatin_.26_Fluorouracil_2|CF]] versus [[#Observation|no further treatment]] | ||
− | ===Variant # | + | ===Variant #3, 100 mg/m<sup>2</sup> x 2 {{#subobject:b44282|Variant=1}}=== |
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
!style="width: 50%"|Study | !style="width: 50%"|Study | ||
Line 214: | Line 233: | ||
'''One course''' | '''One course''' | ||
− | ===Variant # | + | ===Variant #4, 100 mg/m<sup>2</sup> x 3 {{#subobject:aca3c0|Variant=1}}=== |
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
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# '''NPC-9901:''' Lee AW, Tung SY, Chua DT, Ngan RK, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GK, Law SC, O'Sullivan B, Yau TK, Leung TW, Au JS, Sze WM, Choi CW, Fung KK, Lau JT, Lau WH. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2010 Aug 4;102(15):1188-98. Epub 2010 Jul 15. [https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djq258 link to original article] '''contains partial protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/20634482 PubMed] | # '''NPC-9901:''' Lee AW, Tung SY, Chua DT, Ngan RK, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GK, Law SC, O'Sullivan B, Yau TK, Leung TW, Au JS, Sze WM, Choi CW, Fung KK, Lau JT, Lau WH. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2010 Aug 4;102(15):1188-98. Epub 2010 Jul 15. [https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djq258 link to original article] '''contains partial protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/20634482 PubMed] | ||
## '''Update:''' Lee AWM, Tung SY, Ng WT, Lee V, Ngan RKC, Choi HCW, Chan LLK, Siu LL, Ng AWY, Leung TW, Yiu HHY, O'Sullivan B, Chappell R. A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity. Cancer. 2017 Nov 1;123(21):4147-4157. Epub 2017 Jun 29. [https://onlinelibrary.wiley.com/wol1/doi/10.1002/cncr.30850/abstract link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/28662313 PubMed] | ## '''Update:''' Lee AWM, Tung SY, Ng WT, Lee V, Ngan RKC, Choi HCW, Chan LLK, Siu LL, Ng AWY, Leung TW, Yiu HHY, O'Sullivan B, Chappell R. A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity. Cancer. 2017 Nov 1;123(21):4147-4157. Epub 2017 Jun 29. [https://onlinelibrary.wiley.com/wol1/doi/10.1002/cncr.30850/abstract link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/28662313 PubMed] | ||
+ | # Chen QY, Wen YF, Guo L, Liu H, Huang PY, Mo HY, Li NW, Xiang YQ, Luo DH, Qiu F, Sun R, Deng MQ, Chen MY, Hua YJ, Guo X, Cao KJ, Hong MH, Qian CN, Mai HQ. Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst. 2011 Dec 7;103(23):1761-70. Epub 2011 Nov 4. [https://academic.oup.com/jnci/article/103/23/1761/2516849 link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22056739 PubMed] | ||
# Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012 Feb;13(2):163-71. Epub 2011 Dec 7. [https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70320-5/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22154591 PubMed] | # Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012 Feb;13(2):163-71. Epub 2011 Dec 7. [https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70320-5/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22154591 PubMed] | ||
## '''Update:''' Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J. Adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Long-term results of a phase 3 multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:150-158. Epub 2017 Feb 22. [https://www.ejcancer.com/article/S0959-8049(17)30046-1/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/28235726 PubMed] | ## '''Update:''' Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J. Adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Long-term results of a phase 3 multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:150-158. Epub 2017 Feb 22. [https://www.ejcancer.com/article/S0959-8049(17)30046-1/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/28235726 PubMed] | ||
Line 286: | Line 306: | ||
# Cao SM, Yang Q, Guo L, Mai HQ, Mo HY, Cao KJ, Qian CN, Zhao C, Xiang YQ, Zhang XP, Lin ZX, Li WX, Liu Q, Qiu F, Sun R, Chen QY, Huang PY, Luo DH, Hua YJ, Wu YS, Lv X, Wang L, Xia WX, Tang LQ, Ye YF, Chen MY, Guo X, Hong MH. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:14-23. Epub 2017 Feb 16. [https://www.ejcancer.com/article/S0959-8049(17)30058-8/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/28214653 PubMed] | # Cao SM, Yang Q, Guo L, Mai HQ, Mo HY, Cao KJ, Qian CN, Zhao C, Xiang YQ, Zhang XP, Lin ZX, Li WX, Liu Q, Qiu F, Sun R, Chen QY, Huang PY, Luo DH, Hua YJ, Wu YS, Lv X, Wang L, Xia WX, Tang LQ, Ye YF, Chen MY, Guo X, Hong MH. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:14-23. Epub 2017 Feb 16. [https://www.ejcancer.com/article/S0959-8049(17)30058-8/fulltext link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/28214653 PubMed] | ||
# Tang LQ, Chen DP, Guo L, Mo HY, Huang Y, Guo SS, Qi B, Tang QN, Wang P, Li XY, Li JB, Liu Q, Gao YH, Xie FY, Liu LT, Li Y, Liu SL, Xie HJ, Liang YJ, Sun XS, Yan JJ, Wu YS, Luo DH, Huang PY, Xiang YQ, Sun R, Chen MY, Lv X, Wang L, Xia WX, Zhao C, Cao KJ, Qian CN, Guo X, Hong MH, Nie ZQ, Chen QY, Mai HQ. Concurrent chemoradiotherapy with nedaplatin versus cisplatin in stage II-IVB nasopharyngeal carcinoma: an open-label, non-inferiority, randomised phase 3 trial. Lancet Oncol. 2018 Apr;19(4):461-473. Epub 2018 Feb 28. [https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30104-9/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/29501366 PubMed] | # Tang LQ, Chen DP, Guo L, Mo HY, Huang Y, Guo SS, Qi B, Tang QN, Wang P, Li XY, Li JB, Liu Q, Gao YH, Xie FY, Liu LT, Li Y, Liu SL, Xie HJ, Liang YJ, Sun XS, Yan JJ, Wu YS, Luo DH, Huang PY, Xiang YQ, Sun R, Chen MY, Lv X, Wang L, Xia WX, Zhao C, Cao KJ, Qian CN, Guo X, Hong MH, Nie ZQ, Chen QY, Mai HQ. Concurrent chemoradiotherapy with nedaplatin versus cisplatin in stage II-IVB nasopharyngeal carcinoma: an open-label, non-inferiority, randomised phase 3 trial. Lancet Oncol. 2018 Apr;19(4):461-473. Epub 2018 Feb 28. [https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30104-9/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/29501366 PubMed] | ||
+ | |||
+ | ==Cisplatin, Fluorouracil, RT {{#subobject:4c4db1|Regimen=1}}== | ||
+ | {| class="wikitable" style="float:right; margin-left: 5px;" | ||
+ | |- | ||
+ | |[[#top|back to top]] | ||
+ | |} | ||
+ | CF & RT: '''<u>C</u>'''isplatin and '''<u>F</u>'''luorouracil with concurrent '''<u>R</u>'''adiation '''<u>T</u>'''herapy | ||
+ | ===Regimen {{#subobject:59e75d|Variant=1}}=== | ||
+ | {| class="wikitable" style="width: 100%; text-align:center;" | ||
+ | !style="width: 25%"|Study | ||
+ | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | !style="width: 25%"|Comparator | ||
+ | !style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
+ | |- | ||
+ | |[http://ascopubs.org/doi/full/10.1200/JCO.2003.06.158 Lin et al. 2003] | ||
+ | |style="background-color:#1a9851"|Phase III (E) | ||
+ | |[[#Radiation_therapy|RT]] | ||
+ | | style="background-color:#1a9850" |Superior OS | ||
+ | |- | ||
+ | |} | ||
+ | ====Chemoradiotherapy==== | ||
+ | *[[Cisplatin (Platinol)]] 20 mg/m<sup>2</sup> IV once per day on days 1 to 5 | ||
+ | *[[Fluorouracil (5-FU)]] 400 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours on days 1 to 5 (total dose per cycle: 1600 mg/m<sup>2</sup>) | ||
+ | *Concurrent [[External_beam_radiotherapy|radiation therapy]], total dose 70 to 74 Gy | ||
+ | |||
+ | '''28-day cycle for 2 cycles''' | ||
+ | |||
+ | ===References=== | ||
+ | # Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003 Feb 15;21(4):631-7. [http://ascopubs.org/doi/full/10.1200/JCO.2003.06.158 link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/12586799 PubMed] | ||
==Oxaliplatin & RT {{#subobject:308944|Regimen=1}}== | ==Oxaliplatin & RT {{#subobject:308944|Regimen=1}}== |
Revision as of 14:06, 8 October 2018
Section editor | |
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Michael Gibson, MD, PhD Nashville, TN Twitter: mgibson21212 |
26 regimens on this page
39 variants on this page
|
Note: this page has regimens specific to nasopharyngeal carcinoma; more general regimens are available on the head and neck cancer page.
Guidelines
EHNS/ESMO/ESTRO
- 2012: Chan et al. Nasopharyngeal cancer: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Locally advanced disease, induction
Cisplatin & Fluorouracil
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CF: Cisplatin & Fluorouracil
PF: Platinol (Cisplatin) & Fluorouracil
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Cao et al. 2017 | Phase III (E) | No induction | Seems to have superior DFS |
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV once on day 1
- Fluorouracil (5-FU) 800 mg/m2/day IV continuous infusion over 120 hours on days 1 to 5 (total dose per cycle: 4000 mg/m2)
21-day cycle for 2 cycles
Subsequent treatment
References
- Cao SM, Yang Q, Guo L, Mai HQ, Mo HY, Cao KJ, Qian CN, Zhao C, Xiang YQ, Zhang XP, Lin ZX, Li WX, Liu Q, Qiu F, Sun R, Chen QY, Huang PY, Luo DH, Hua YJ, Wu YS, Lv X, Wang L, Xia WX, Tang LQ, Ye YF, Chen MY, Guo X, Hong MH. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:14-23. Epub 2017 Feb 16. link to original article contains protocol PubMed
DCF
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DCF: Docetaxel, Cisplatin, Fluorouracil
TPF: Taxotere (Docetaxel), Platinol (Cisplatin), Fluorouracil
Variant #1, 60/60/3000
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Sun et al. 2016 | Phase III (E) | No induction | Seems to have superior FFS |
Chemotherapy
- Docetaxel (Taxotere) 60 mg/m2 IV once on day 1
- Cisplatin (Platinol) 60 mg/m2 IV once on day 1
- Fluorouracil (5-FU) 600 mg/m2/day IV continuous infusion over 120 hours on days 1 to 5 (total dose per cycle: 3000 mg/m2)
21-day cycle for 3 cycles
Subsequent treatment
Variant #2, 70/75/4000
Study | Evidence |
---|---|
Bae et al. 2010 | Phase II |
This study only involved patients with locoregionally advanced nasopharyngeal cancer.
Chemotherapy
- Docetaxel (Taxotere) 70 mg/m2 in 300 mL normal saline IV over 60 minutes once on day 1, given first
- Cisplatin (Platinol) 75 mg/m2 IV over 3 hours once on day 1, given second
- Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 4 days on days 1 to 4, started after completion of cisplatin (total dose per cycle: 4000 mg/m2)
Supportive medications
- Dexamethasone (Decadron) 20 mg IV once 30 minutes prior to Docetaxel (Taxotere)
- Ranitidine (Zantac) 50 mg IV once 30 minutes prior to Docetaxel (Taxotere)
- Chlorpheniramine (Chlor-Trimeton) 5 mg IV once 30 minutes prior to Docetaxel (Taxotere)
- Posthydration after Cisplatin (Platinol) with normal saline (volume/rate not specified)
- Ondansetron (Zofran) 8 mg IV "was routinely given"
- Levofloxacin (Levaquin) 500 mg PO once per day on days 5 to 10 as prophylaxis
- Prophylactic G-CSF per physician's discretion
21-day cycle for 3 cycles
Subsequent treatment
References
- Bae WK, Hwang JE, Shim HJ, Cho SH, Lee JK, Lim SC, Chung WK, Chung IJ. Phase II study of docetaxel, cisplatin, and 5-FU induction chemotherapy followed by chemoradiotherapy in locoregionally advanced nasopharyngeal cancer. Cancer Chemother Pharmacol. 2010 Feb;65(3):589-95. link to original article contains verified protocol PubMed
- Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, Sun Y, Chen XZ, Li JG, Zhu XD, Hu CS, Xu XY, Chen YY, Hu WH, Guo L, Mo HY, Chen L, Mao YP, Sun R, Ai P, Liang SB, Long GX, Zheng BM, Feng XL, Gong XC, Li L, Shen CY, Xu JY, Guo Y, Chen YM, Zhang F, Lin L, Tang LL, Liu MZ, Ma J. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016 Nov;17(11):1509-1520. Epub 2016 Sep 26. link to original article contains verified protocol PubMed
No induction
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Sun et al. 2016 | Phase III (C) | TPF | Seems to have inferior FFS |
No therapy given prior to definitive chemoradiotherapy.
Subsequent treatment
References
- Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, Sun Y, Chen XZ, Li JG, Zhu XD, Hu CS, Xu XY, Chen YY, Hu WH, Guo L, Mo HY, Chen L, Mao YP, Sun R, Ai P, Liang SB, Long GX, Zheng BM, Feng XL, Gong XC, Li L, Shen CY, Xu JY, Guo Y, Chen YM, Zhang F, Lin L, Tang LL, Liu MZ, Ma J. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016 Nov;17(11):1509-1520. Epub 2016 Sep 26. link to original article contains verified protocol PubMed
- Cao SM, Yang Q, Guo L, Mai HQ, Mo HY, Cao KJ, Qian CN, Zhao C, Xiang YQ, Zhang XP, Lin ZX, Li WX, Liu Q, Qiu F, Sun R, Chen QY, Huang PY, Luo DH, Hua YJ, Wu YS, Lv X, Wang L, Xia WX, Tang LQ, Ye YF, Chen MY, Guo X, Hong MH. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:14-23. Epub 2017 Feb 16. link to original article contains protocol PubMed
Locally advanced disease, definitive chemoradiotherapy
Carboplatin & RT
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RT: Radiation Therapy
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Chitapanarux et al. 2007 | Phase III (E) | Cisplatin & RT, then CF | Seems to be non-inferior |
Chemoradiotherapy
- Carboplatin (Paraplatin) 100 mg/m2 IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36
- Concurrent radiation therapy to the primary tumor, 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks
7-week course
Subsequent treatment
- Carboplatin & fluorouracil consolidation, after 4 weeks
References
- Chitapanarux I, Lorvidhaya V, Kamnerdsupaphon P, Sumitsawan Y, Tharavichitkul E, Sukthomya V, Ford J. Chemoradiotherapy comparing cisplatin versus carboplatin in locally advanced nasopharyngeal cancer: randomised, non-inferiority, open trial. Eur J Cancer. 2007 Jun;43(9):1399-406. Epub 2007 Apr 27. link to original article contains verified protocol PubMed
Cisplatin & RT
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Cisplatin & RT: Cisplatin & Radiation Therapy
Variant #1, 30 mg/m2 weekly dosing
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Chen et al. 2011a | Phase III (E) | Radiation therapy | Superior OS |
Chemoradiotherapy
- Cisplatin (Platinol) 30 mg/m2 IV once per week, during radiation
- Concurrent radiation therapy, total dose of 68 to 70 Gy
One course
Variant #2, 40 mg/m2 weekly dosing
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Chan et al. 2002 | Phase III (E) | Radiation therapy | Might have superior OS (*) |
Chen et al. 2011b | Non-randomized portion of RCT |
Note: reported efficacy for Chan et al. 2002 is based on the 2005 update.
Chemoradiotherapy
- Cisplatin (Platinol) 40 mg/m2 in 1 liter normal saline IV over 2 hours once per day on days 1, 8, 15, 22, 29, 36, 43
- Concurrent radiation therapy, 2 Gy fractions x 33 fractions (total dose: 66 Gy), given 5 times per week over 6.5 weeks. See Chan et al. 2005 for additional information about boost doses.
One course
Subsequent treatment
- Chen et al. 2011: CF versus no further treatment
Variant #3, 100 mg/m2 x 2
Study | Evidence |
---|---|
Bae et al. 2010 | Phase II |
Chemoradiotherapy
- Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1 & 22
- Concurrent radiation therapy: 1.8 to 2 Gy fractions (total dose: 68.4 Gy), given 5 times per week
One course
Variant #4, 100 mg/m2 x 3
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Al-Sarraf et al. 1998 (Intergroup 0099) | Phase III (E) | Radiation therapy | Superior OS |
Wee et al. 2005 | Phase III (E) | Radiation therapy | Superior OS |
Chitapanarux et al. 2007 | Phase III (C) | Carboplatin & RT, then Carboplatin & 5-FU | Seems to be non-inferior |
Lee et al. 2010 (NPC-9901) | Phase III (E) | Radiation therapy | Seems to have superior OS (*) |
Sun et al. 2016 | Non-randomized portion of RCT | ||
Tang et al. 2018 | Phase III (C) | Nedaplatin & RT | Non-inferior PFS at 2 y |
Intergroup 0099 involved patients with stage III and IV nasopharynx cancers without evidence of metastases. Efficacy for NPC-9901 is based on the 2016 update.
Chemoradiotherapy
- Cisplatin (Platinol) 100 mg/m2 IV once per day on days 1, 22, 43
- Wee et al. 2005 gave 25 mg/m2 IV once per day on days 1 to 4, 22 to 25, 43 to 46
- Concurrent radiation therapy with one of the following:
- Intergroup 0099: 1.8 to 2 Gy fractions x 35 to 39 fractions to the primary tumor (total dose: 70 Gy), given 5 times per week. Minimum total dose to neck nodes is 50 Gy for N0 disease; 66 Gy for nodes less than or equal to 2 cm in size; 70 Gy for nodes greater than 2 cm.
- Chitapanarux et al. 2007: 2 Gy fractions x 35 fractions (total dose: 70 Gy), given 5 times per week over 7 weeks
- Sun et al. 2016: see paper for details
Supportive medications
- Best described by Al-Sarraf et al. 1998
- Forced hydration: 5% dextrose in 1/2 normal saline with 40 mEq KCl, 2000 mL IV continuous infusion over 24 hours given twice, before each dose of Cisplatin (Platinol) and after the second mannitol infusion
- Mannitol 12.5 g IV bolus prior to Cisplatin (Platinol)
- 5% dextrose in 1/2 normal saline with 30 mEq KCl and mannitol 25 g, 1000 mL IV over 4 hours immediately after Cisplatin (Platinol)
- Antiemetic such as Prochlorperazine (Compazine) 25 mg rectal suppository given 30 minutes prior to Cisplatin (Platinol); Prochlorperazine (Compazine) 10 mg IM every 4 hours as needed for nausea after Cisplatin (Platinol)
One course
Subsequent treatment
- Most studies: Adjuvant CF
References
- Intergroup 0099: Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998 Apr;16(4):1310-7. link to original article contains verified protocol PubMed
- Chan AT, Teo PM, Ngan RK, Leung TW, Lau WH, Zee B, Leung SF, Cheung FY, Yeo W, Yiu HH, Yu KH, Chiu KW, Chan DT, Mok T, Yuen KT, Mo F, Lai M, Kwan WH, Choi P, Johnson PJ. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol. 2002 Apr 15;20(8):2038-44. link to original article PubMed
- Update: Chan AT, Leung SF, Ngan RK, Teo PM, Lau WH, Kwan WH, Hui EP, Yiu HY, Yeo W, Cheung FY, Yu KH, Chiu KW, Chan DT, Mok TS, Yau S, Yuen KT, Mo FK, Lai MM, Ma BB, Kam MK, Leung TW, Johnson PJ, Choi PH, Zee BC. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005 Apr 6;97(7):536-9. link to original article contains verified protocol PubMed
- Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, Chua ET, Yang E, Lee KM, Fong KW, Tan HS, Lee KS, Loong S, Sethi V, Chua EJ, Machin D. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol. 2005 Sep 20;23(27):6730-8. link to original article PubMed
- Chitapanarux I, Lorvidhaya V, Kamnerdsupaphon P, Sumitsawan Y, Tharavichitkul E, Sukthomya V, Ford J. Chemoradiotherapy comparing cisplatin versus carboplatin in locally advanced nasopharyngeal cancer: randomised, non-inferiority, open trial. Eur J Cancer. 2007 Jun;43(9):1399-406. Epub 2007 Apr 27. link to original article contains verified protocol PubMed
- Bae WK, Hwang JE, Shim HJ, Cho SH, Lee JK, Lim SC, Chung WK, Chung IJ. Phase II study of docetaxel, cisplatin, and 5-FU induction chemotherapy followed by chemoradiotherapy in locoregionally advanced nasopharyngeal cancer. Cancer Chemother Pharmacol. 2010 Feb;65(3):589-95. link to original article contains verified protocol PubMed
- NPC-9901: Lee AW, Tung SY, Chua DT, Ngan RK, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GK, Law SC, O'Sullivan B, Yau TK, Leung TW, Au JS, Sze WM, Choi CW, Fung KK, Lau JT, Lau WH. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2010 Aug 4;102(15):1188-98. Epub 2010 Jul 15. link to original article contains partial protocol PubMed
- Update: Lee AWM, Tung SY, Ng WT, Lee V, Ngan RKC, Choi HCW, Chan LLK, Siu LL, Ng AWY, Leung TW, Yiu HHY, O'Sullivan B, Chappell R. A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity. Cancer. 2017 Nov 1;123(21):4147-4157. Epub 2017 Jun 29. link to original article PubMed
- Chen QY, Wen YF, Guo L, Liu H, Huang PY, Mo HY, Li NW, Xiang YQ, Luo DH, Qiu F, Sun R, Deng MQ, Chen MY, Hua YJ, Guo X, Cao KJ, Hong MH, Qian CN, Mai HQ. Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst. 2011 Dec 7;103(23):1761-70. Epub 2011 Nov 4. link to original article contains protocol PubMed
- Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012 Feb;13(2):163-71. Epub 2011 Dec 7. link to original article contains protocol PubMed
- Update: Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J. Adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Long-term results of a phase 3 multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:150-158. Epub 2017 Feb 22. link to original article PubMed
- Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, Sun Y, Chen XZ, Li JG, Zhu XD, Hu CS, Xu XY, Chen YY, Hu WH, Guo L, Mo HY, Chen L, Mao YP, Sun R, Ai P, Liang SB, Long GX, Zheng BM, Feng XL, Gong XC, Li L, Shen CY, Xu JY, Guo Y, Chen YM, Zhang F, Lin L, Tang LL, Liu MZ, Ma J. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. Lancet Oncol. 2016 Nov;17(11):1509-1520. Epub 2016 Sep 26. link to original article contains verified protocol PubMed
- Cao SM, Yang Q, Guo L, Mai HQ, Mo HY, Cao KJ, Qian CN, Zhao C, Xiang YQ, Zhang XP, Lin ZX, Li WX, Liu Q, Qiu F, Sun R, Chen QY, Huang PY, Luo DH, Hua YJ, Wu YS, Lv X, Wang L, Xia WX, Tang LQ, Ye YF, Chen MY, Guo X, Hong MH. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase III multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:14-23. Epub 2017 Feb 16. link to original article PubMed
- Tang LQ, Chen DP, Guo L, Mo HY, Huang Y, Guo SS, Qi B, Tang QN, Wang P, Li XY, Li JB, Liu Q, Gao YH, Xie FY, Liu LT, Li Y, Liu SL, Xie HJ, Liang YJ, Sun XS, Yan JJ, Wu YS, Luo DH, Huang PY, Xiang YQ, Sun R, Chen MY, Lv X, Wang L, Xia WX, Zhao C, Cao KJ, Qian CN, Guo X, Hong MH, Nie ZQ, Chen QY, Mai HQ. Concurrent chemoradiotherapy with nedaplatin versus cisplatin in stage II-IVB nasopharyngeal carcinoma: an open-label, non-inferiority, randomised phase 3 trial. Lancet Oncol. 2018 Apr;19(4):461-473. Epub 2018 Feb 28. link to original article contains protocol PubMed
Cisplatin, Fluorouracil, RT
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CF & RT: Cisplatin and Fluorouracil with concurrent Radiation Therapy
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Lin et al. 2003 | Phase III (E) | RT | Superior OS |
Chemoradiotherapy
- Cisplatin (Platinol) 20 mg/m2 IV once per day on days 1 to 5
- Fluorouracil (5-FU) 400 mg/m2/day IV continuous infusion over 96 hours on days 1 to 5 (total dose per cycle: 1600 mg/m2)
- Concurrent radiation therapy, total dose 70 to 74 Gy
28-day cycle for 2 cycles
References
- Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol. 2003 Feb 15;21(4):631-7. link to original article contains protocol PubMed
Oxaliplatin & RT
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RT: Radiation Therapy
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Zhang et al. 2005 | Phase III (E) | RT | Seems to have superior OS (*) |
Note: Reported efficacy is based on the 2013 update.
Chemoradiotherapy
- Oxaliplatin (Eloxatin) 70 mg/m2 IV once per week (6 doses)
- Concurrent radiation therapy to primary tumor (70 to 74 Gy).
6-week course
References
- Zhang L, Zhao C, Peng PJ, Lu LX, Huang PY, Han F, Wu SX. Phase III study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma: preliminary results. J Clin Oncol. 2005 Nov 20;23(33):8461-8. Epub 2005 Oct 17. link to original article contains verified protocol PubMed
- Update: Wu X, Huang PY, Peng PJ, Lu LX, Han F, Wu SX, Hou X, Zhao HY, Huang Y, Fang WF, Zhao YY, Xue C, Hu ZH, Zhang J, Zhang JW, Ma YX, Liang WH, Zhao C, Zhang L. Long-term follow-up of a phase III study comparing radiotherapy with or without weekly oxaliplatin for locoregionally advanced nasopharyngeal carcinoma. Ann Oncol. 2013 Aug;24(8):2131-6. Epub 2013 May 9. link to original article PubMed
Radiation therapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Al-Sarraf et al. 1998 (Intergroup 0099) | Phase III (C) | Cisplatin & RT, then CF | Inferior OS |
Chan et al. 2002 | Phase III (C) | Cisplatin & RT | Might have inferior OS (*) |
Wee et al. 2005 | Phase III (C) | Cisplatin & RT | Inferior OS |
Lee et al. 2010 (NPC-9901) | Phase III (C) | Cisplatin & RT | Seems to have inferior OS (*) |
Efficacy for Chan et al. 2002 is based on the 2005 update. Efficacy for NPC-9901 is based on the 2016 update. Here for reference purposes.
Radiotherapy
References
- Intergroup 0099: Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998 Apr;16(4):1310-7. link to original article contains verified protocol PubMed
- Chan AT, Teo PM, Ngan RK, Leung TW, Lau WH, Zee B, Leung SF, Cheung FY, Yeo W, Yiu HH, Yu KH, Chiu KW, Chan DT, Mok T, Yuen KT, Mo F, Lai M, Kwan WH, Choi P, Johnson PJ. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol. 2002 Apr 15;20(8):2038-44. link to original article PubMed
- Update: Chan AT, Leung SF, Ngan RK, Teo PM, Lau WH, Kwan WH, Hui EP, Yiu HY, Yeo W, Cheung FY, Yu KH, Chiu KW, Chan DT, Mok TS, Yau S, Yuen KT, Mo FK, Lai MM, Ma BB, Kam MK, Leung TW, Johnson PJ, Choi PH, Zee BC. Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2005 Apr 6;97(7):536-9. link to original article contains verified protocol PubMed
- Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, Chua ET, Yang E, Lee KM, Fong KW, Tan HS, Lee KS, Loong S, Sethi V, Chua EJ, Machin D. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol. 2005 Sep 20;23(27):6730-8. link to original article PubMed
- Zhang L, Zhao C, Peng PJ, Lu LX, Huang PY, Han F, Wu SX. Phase III study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma: preliminary results. J Clin Oncol. 2005 Nov 20;23(33):8461-8. Epub 2005 Oct 17. link to original article contains verified protocol PubMed
- Update: Wu X, Huang PY, Peng PJ, Lu LX, Han F, Wu SX, Hou X, Zhao HY, Huang Y, Fang WF, Zhao YY, Xue C, Hu ZH, Zhang J, Zhang JW, Ma YX, Liang WH, Zhao C, Zhang L. Long-term follow-up of a phase III study comparing radiotherapy with or without weekly oxaliplatin for locoregionally advanced nasopharyngeal carcinoma. Ann Oncol. 2013 Aug;24(8):2131-6. Epub 2013 May 9. link to original article PubMed
- NPC-9901: Lee AW, Tung SY, Chua DT, Ngan RK, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GK, Law SC, O'Sullivan B, Yau TK, Leung TW, Au JS, Sze WM, Choi CW, Fung KK, Lau JT, Lau WH. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2010 Aug 4;102(15):1188-98. Epub 2010 Jul 15. link to original article contains partial protocol PubMed
- Update: Lee AWM, Tung SY, Ng WT, Lee V, Ngan RKC, Choi HCW, Chan LLK, Siu LL, Ng AWY, Leung TW, Yiu HHY, O'Sullivan B, Chappell R. A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity. Cancer. 2017 Nov 1;123(21):4147-4157. Epub 2017 Jun 29. link to original article PubMed
Adjuvant therapy
Carboplatin & Fluorouracil
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Regimen
Study | Evidence |
---|---|
Chitapanarux et al. 2007 | Non-randomized portion of RCT |
Preceding treatment
Chemotherapy
- Carboplatin (Paraplatin) AUC 5 IV once on day 1
- Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 4000 mg/m2)
28-day cycle for 3 cycles
References
- Chitapanarux I, Lorvidhaya V, Kamnerdsupaphon P, Sumitsawan Y, Tharavichitkul E, Sukthomya V, Ford J. Chemoradiotherapy comparing cisplatin versus carboplatin in locally advanced nasopharyngeal cancer: randomised, non-inferiority, open trial. Eur J Cancer. 2007 Jun;43(9):1399-406. Epub 2007 Apr 27. link to original article contains verified protocol PubMed
Cisplatin & Fluorouracil
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Cisplatin and Fluorouracil
Variant #1, 80/4000, 4 days of 5-FU
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Al-Sarraf et al. 1998 (Intergroup 0099) | Non-randomized portion of RCT | ||
Wee et al. 2005 | Non-randomized portion of RCT | ||
Chitapanarux et al. 2007 | Phase III (C) | Carboplatin & RT, then Carboplatin & 5-FU | Seems to be non-inferior |
Lee et al. 2010 (NPC-9901) | Non-randomized portion of RCT |
Preceding treatment
- Intergroup 0099 & Wee et al. 2005: Cisplatin & RT versus RT
- Chitapanarux et al. 2007 & NPC-9901: Cisplatin & RT
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV over 15 to 20 minutes once on day 1
- Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (total dose per cycle: 4000 mg/m2)
28-day cycle for 3 cycles
Variant #2, 80/4000, 5 days of 5-FU
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Chen et al. 2011 | Phase III (E) | No further treatment | Seems not superior |
Preceding treatment
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV once on day 1
- Fluorouracil (5-FU) 800 mg/m2/day IV continuous infusion over 120 hours on days 1 to 5 (total dose per cycle: 4000 mg/m2)
28-day cycle for 3 cycles
References
- Intergroup 0099: Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998 Apr;16(4):1310-7. link to original article contains verified protocol PubMed
- Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, Chua ET, Yang E, Lee KM, Fong KW, Tan HS, Lee KS, Loong S, Sethi V, Chua EJ, Machin D. Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol. 2005 Sep 20;23(27):6730-8. link to original article contains protocol PubMed
- Chitapanarux I, Lorvidhaya V, Kamnerdsupaphon P, Sumitsawan Y, Tharavichitkul E, Sukthomya V, Ford J. Chemoradiotherapy comparing cisplatin versus carboplatin in locally advanced nasopharyngeal cancer: randomised, non-inferiority, open trial. Eur J Cancer. 2007 Jun;43(9):1399-406. Epub 2007 Apr 27. link to original article contains verified protocol PubMed
- NPC-9901: Lee AW, Tung SY, Chua DT, Ngan RK, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GK, Law SC, O'Sullivan B, Yau TK, Leung TW, Au JS, Sze WM, Choi CW, Fung KK, Lau JT, Lau WH. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2010 Aug 4;102(15):1188-98. Epub 2010 Jul 15. link to original article contains partial protocol PubMed
- Update: Lee AWM, Tung SY, Ng WT, Lee V, Ngan RKC, Choi HCW, Chan LLK, Siu LL, Ng AWY, Leung TW, Yiu HHY, O'Sullivan B, Chappell R. A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity. Cancer. 2017 Nov 1;123(21):4147-4157. Epub 2017 Jun 29. link to original article PubMed
- Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J. Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2012 Feb;13(2):163-71. Epub 2011 Dec 7. link to original article contains protocol PubMed
- Update: Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J. Adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Long-term results of a phase 3 multicentre randomised controlled trial. Eur J Cancer. 2017 Apr;75:150-158. Epub 2017 Feb 22. link to original article PubMed
Recurrent or metastatic disease
Cisplatin & Fluorouracil
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CF: Cisplatin and Fluorouracil
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Zhang et al. 2016 | Phase III (C) | Cisplatin & Gemcitabine | Inferior PFS |
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV once on day 1
- Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion on days 1 to 4 (total dose per cycle: 4000 mg/m2)
21-day cycle for up to 6 cycles
References
- Zhang L, Huang Y, Hong S, Yang Y, Yu G, Jia J, Peng P, Wu X, Lin Q, Xi X, Peng J, Xu M, Chen D, Lu X, Wang R, Cao X, Chen X, Lin Z, Xiong J, Lin Q, Xie C, Li Z, Pan J, Li J, Wu S, Lian Y, Yang Q, Zhao C. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma:a multicentre, randomised, open-label, phase 3 trial. Lancet. 2016 Oct 15;388(10054):1883-1892. Epub 2016 Aug 23. link to original article contains protocol PubMed
Cisplatin & Gemcitabine
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Zhang et al. 2016 | Phase III (E) | CF | Superior PFS |
Chemotherapy
- Cisplatin (Platinol) 80 mg/m2 IV once on day 1
- Gemcitabine (Gemzar) 1000 mg/m2/day IV once per day on days 1 & 8
21-day cycle for up to 6 cycles
References
- Zhang L, Huang Y, Hong S, Yang Y, Yu G, Jia J, Peng P, Wu X, Lin Q, Xi X, Peng J, Xu M, Chen D, Lu X, Wang R, Cao X, Chen X, Lin Z, Xiong J, Lin Q, Xie C, Li Z, Pan J, Li J, Wu S, Lian Y, Yang Q, Zhao C. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma:a multicentre, randomised, open-label, phase 3 trial. Lancet. 2016 Oct 15;388(10054):1883-1892. Epub 2016 Aug 23. link to original article contains protocol PubMed
Gemcitabine monotherapy
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Regimen
Study | Evidence |
---|---|
Zhang et al. 2008 | Phase II |
This study only involved patients who had already received previous platinum-based chemotherapy.
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 in 100 mL normal saline IV over 30 minutes once per day on days 1, 8, 15
Supportive medications
- 5-HT3 receptor antagonists prior to chemotherapy
- G-CSF and GM-CSF were not used
28-day cycles
References
- Zhang L, Zhang Y, Huang PY, Xu F, Peng PJ, Guan ZZ. Phase II clinical study of gemcitabine in the treatment of patients with advanced nasopharyngeal carcinoma after the failure of platinum-based chemotherapy. Cancer Chemother Pharmacol. 2008 Jan;61(1):33-8. Epub 2007 Mar 20. link to original article contains verified protocol PubMed