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Cancer Sci. 2017 Dec 21. doi: 10.1111/cas.13474. [Epub ahead of print]

The Optimal Cumulative Cisplatin Dose in Nasopharyngeal Carcinoma Patients Receiving Additional Induction Chemotherapy.

Author information

1
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
2
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States.
3
Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA.
4
Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.

Abstract

To clarify the optimal cumulative cisplatin dose (CCD) in locoregionally-advanced nasopharyngel carcinoma (NPC) patients receiving induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT). Using the NPC-specific database from the established big-data intelligence platform at Sun Yat-Sen University Cancer Center, 583 non-disseminated, locoregionally-advanced NPC patients receiving IC plus CCRT were enrolled. Propensity score matching (PSM) analysis was conducted to control for confounding factors.The median CCD was 160 mg/m2 after IC (range, 40-300mg/m2 ); only 74 patients (12.7%) achieved CCD>200 mg/m2 . Patients receiving>200 mg/m2 CCD did not show significantly improved 5-year overall survival (OS) (HR=1.19; 95% confidence intervals [CI] 0.69-2.06,P=0.53) and progression-free survival (PFS) (HR=1.03; 95% CI 0.63-1.68,P=0.92) compared with patients receiving<200 mg/m2 CCD. Further investigations of the potential of median CCD (160 mg/m2 ) to yield survival benefits revealed that there were no significant differences in survival endpoints between patients receiving CCD>160 mg/m2 and CCD<160 mg/m2 in both the original and PSM cohorts. Additionally, subgroup analysis indicated a favourable PFS, but not OS, with higher cisplatin administration in patients with pretreatment Epstein-Barr virus deoxyribonucleic acid (EBV DNA)<1000 copies/ml (HR=0.26, 95% CI 0.07-0.93,P=0.03) and receiving<3 IC cycles (HR=0.59, 95% CI 0.33-1.07,P=0.08). Our analysis of real world data provided references for the optimal CCD in locoregionally-advanced NPC receiving additional IC. The causal relationship between 200 mg/m2 CCD and improved survival was not defined; 160 mg/m2 CCD might be enough. However, for patients with EBV DNA<1000 copy/ml, and receiving<3 IC cycles, higher dose might be necessary. This article is protected by copyright. All rights reserved.

KEYWORDS:

Cumulative cisplatin dose; Induction chemotherapy; Intensity-modulated radiation therapy; Nasopharyngeal carcinoma; Real world data

PMID:
29266526
DOI:
10.1111/cas.13474
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