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Bevacizumab plus cisplatin and helical tomotherapy in treatment of locally advanced nasopharyngeal carcinoma.

ABSTRACT: BACKGROUND:In recent years, chemotherapy, radiotherapy, and targeted drugs have been respectively used in nasopharyngeal carcinoma. In our research, we combined all of them for better curative effects. MATERIALS AND METHODS:Thirty patients with histologically confirmed stage III~IV (without distant metastasis) nasopharyngeal carcinoma were recruited between December 2013 and October 2014 with strict eligibility requirements and exclusion criteria. Bevacizumab 5 mg/kg, 80 mg/m(2) cisplatin and 67.5 Gy radiotherapy (helical tomotherapy [TOMO]) was given according to standard treatment protocols. RESULTS:After 3 months, 24 complete responses (80%) and six partial responses (40%) were observed in our research. Twenty-four patients (80%) experienced oropharyngeal mucositis, 26% patients experienced weight loss caused by pharyngeal pain and dysphagia caused by oropharyngeal mucositis. CONCLUSION:Bevacizumab plus cisplatin and TOMO in treatment of locally advanced nasopharyngeal carcinoma can increase curative effects with low side effects and toxicities.

SUBMITTER: Li J

PROVIDER: S-EPMC4459609 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Bevacizumab plus cisplatin and helical tomotherapy in treatment of locally advanced nasopharyngeal carcinoma.

Li Jianxiong J Zhao Zhifei Z Wu Xuan X Yao Jie J Ma Lin L Ye Rui R Niu Baolong B Liang Lanqing L Zhao Xiao X Wang Qianqian Q

OncoTargets and therapy 20150602

<h4>Background</h4>In recent years, chemotherapy, radiotherapy, and targeted drugs have been respectively used in nasopharyngeal carcinoma. In our research, we combined all of them for better curative effects.<h4>Materials and methods</h4>Thirty patients with histologically confirmed stage III~IV (without distant metastasis) nasopharyngeal carcinoma were recruited between December 2013 and October 2014 with strict eligibility requirements and exclusion criteria. Bevacizumab 5 mg/kg, 80 mg/m(2) c ...[more]

PMID: 26082647

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Project description:Objective: The objective of this trial is to evaluate and compare the acute toxicity in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated with docetaxel plus cisplatin, or docetaxel, or cisplatin concurrently with helical tomotherapy during concurrent chemoradiotherapy (CCRT). Methods: In a prospective, single-center, open-label, randomized phase II study, after 2 cycles of induction chemotherapy with docetaxel plus cisplatin regimen, 125 patients with LA-NPC (stage III and IVA, UICC eighth) diagnosed pathologically from June 2017 to November 2019 were randomized into CCRT with docetaxel plus cisplatin group (25 patients), CCRT with docetaxel group (50 patients), and CCRT with cisplatin group (50 patients). The incidence of grade 3 or 4 acute toxicities and clinical efficacy were analyzed among the 3 groups. Results: Safety evaluation was completed in all the 125 patients, during the CCRT period, 66.4% of patients completed 3 cycles of chemotherapy, 24.0% completed 2 cycles of chemotherapy, and 9.6% completed 1 cycle of chemotherapy according to the research plan. The incidence of grade 3 or 4 acute toxicity in CCRT with docetaxel plus cisplatin (DP), docetaxel (D), and cisplatin (P) groups was 88.0%, 72.0%, and 56.0%, respectively. The incidence of grade 3 or 4 acute toxicities in the DP group was significantly higher than that in the D and P groups (P = .015), no significant difference was detected between the D and P groups (P = .096). The most common toxicities were mucositis (40.0%), leukopenia (29.6%), neutropenia (26.4%), and pharyngo-esophagitis (12.0%); compared to D and P groups, DP group did not significantly improved the 3-year overall survival (96.0% vs 87.0% and 87.6%), progression-free survival (92.0% vs 79.7% and,76.9%), locoregional failure-free survival (96.0% vs 91.8% and 92.7%), and distant failure-free survival (100% vs 90.0% and 89.0%), there were no significant difference in survival data among the 3 groups (all P > .05). Conclusions: Higher survival benefits did not achieve from intensified CCRT with DP, CCRT with P or D obtained similar short-term survival outcomes with similar acceptable toxicities in LA-NPC patients.

Project description:PurposeInduction chemotherapy plus concurrent chemoradiotherapy and concurrent chemoradiotherapy alone are both standard treatment regimens for managing locally advanced nasopharyngeal carcinoma. However, the results of comparisons between them in clinical trials vary. Therefore, we designed this meta-analysis to illustrate their advantages and disadvantages in patients with locally advanced nasopharyngeal carcinoma.MethodsWe thoroughly searched the PubMed, EMBASE, and Cochrane Library databases and then merged the effect indicators of hazard ratios and risk ratios using RevMan 5.1.ResultsSeven randomized controlled trials totaling 2,319 patients were included in our research. The synthesized results showed that induction chemotherapy plus concurrent chemoradiotherapy improved overall survival (HR = 0.75, 95% CI: 0.63-0.89, P = 0.001), progression-free survival (HR = 0.69, 95% CI: 0.60-0.80, P < 0.001), distant metastasis-free survival (HR = 0.65, 95% CI: 0.53-0.80, P < 0.001) and locoregional recurrence-free survival (HR = 0.68 95%, CI: 0.54-0.86, P = 0.001) versus concurrent chemoradiotherapy alone. It also increased the risk of anemia, thrombocytopenia, and neutropenia during concurrent chemoradiotherapy. However, the incidence of leukopenia and mucositis was similar in induction chemotherapy and induction chemotherapy plus concurrent chemoradiotherapy. Furthermore, the subgroup analysis showed better survival outcomes with induction chemotherapy plus concurrent chemoradiotherapy than with concurrent chemoradiotherapy alone in the triweekly cisplatin subgroup (all P < 0.01), whereas induction chemotherapy plus concurrent chemoradiotherapy could only improve progression-free survival and locoregional recurrence-free survival in the weekly cisplatin subgroup (HR = 0.78, P = 0.02; and HR = 0.66, P = 0.03, respectively).ConclusionsInduction chemotherapy plus concurrent chemoradiotherapy improved survival outcomes in patients with locally advanced nasopharyngeal carcinoma versus concurrent chemoradiotherapy. For the weekly cisplatin regimen subgroup, it did not improve remote control or overall survival versus concurrent chemoradiotherapy alone, warranting further clarification.

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Bevacizumab plus cisplatin and helical tomotherapy in treatment of locally advanced nasopharyngeal carcinoma.

Publications

Bevacizumab plus cisplatin and helical tomotherapy in treatment of locally advanced nasopharyngeal carcinoma.

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