Palliative chemotherapy in carcinoma nasopharynx

Vijay M. Patil; Amit Joshi; Vanita Noronha; Vikas Talreja; Vijai Simha; Sachin Dhumal; Bhavesh Bandekar; Arun Chandrasekharan; Kumar Prabhash

doi:10.4103/sajc.sajc_230_18

South Asian Journal of Cancer, Table of Contents

CC BY-NC-ND 4.0 · South Asian J Cancer 2019; 08(03): 173-177
DOI: 10.4103/sajc.sajc_230_18

ORIGINAL ARTICLE: Head and Neck Cancers

Palliative chemotherapy in carcinoma nasopharynx

Vijay M. Patil

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

,

Amit Joshi

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

,

Vanita Noronha

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

,

Vikas Talreja

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

,

Vijai Simha

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

,

Sachin Dhumal

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

,

Bhavesh Bandekar

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

,

Arun Chandrasekharan

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

,

Kumar Prabhash

Department of Medical Oncology, HBNI, Tata Memorial Hospital, Mumbai, Maharashtra, India

› Author Affiliations

Abstract

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Abstract

Introduction: Nasopharyngeal carcinoma is a rare malignancy. We conducted an audit of systemic therapies received in palliative setting in carcinoma nasopharynx and studied their outcomes. Methods: Patients who underwent first-line palliative systemic chemotherapy between January 2014 and April 2017 for carcinoma nasopharynx at the department of medical oncology at authors' institute were selected for this analysis. Toxicities, responses, progression-free survival (PFS), and overall survival (OS) were analyzed. In addition, a Quality-Adjusted Time without Symptoms or Toxicity analysis with threshold utility analysis was performed. Results: Fifty-one patients were included in this analysis. The indication of palliative chemotherapy was locoregionally recurrent disease in 25 (49.0%) patients and metastatic disease in 26 (51.0%) patients. The overall response rate was 62.0% (n = 33). The median PFS was 225 days (95% confidence interval [CI]: 164–274 days) and median OS was 513 days (95% CI: 286–931 days). The restricted mean TOX state duration was 2.6 days (95% CI: 0.3–4.9), restricted mean TWiST duration was 219.2 days (95% CI: 184.0–254.4), and restricted mean REL duration was 74.3 days (95% CI: 38.1–110.4). Conclusion: Systemic cytotoxic therapy in nasopharyngeal cancers is associated with high response rates and clinically meaningful PFS; with low duration of time spent in adverse events.

Key words

Chemotherapy - nasopharynx - palliative - Quality-adjusted Time without Symptoms or Toxicity - systemic

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References

References
1 Tang LL, Chen WQ, Xue WQ, He YQ, Zheng RS, Zeng YX, et al. Global trends in incidence and mortality of nasopharyngeal carcinoma. Cancer Lett 2016;374:22-30.
2 Kataki AC, Simons MJ, Das AK, Sharma K, Mehra NK. Nasopharyngeal carcinoma in the Northeastern states of India. Chin J Cancer 2011;30:106-13.
3 Chang ET, Adami HO. The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev 2006;15:1765-77.
4 Corry J, Fisher R, Rischin D, Peters LJ. Relapse patterns in WHO 2/3 nasopharyngeal cancer: Is there a difference between ethnic Asian vs. non-Asian patients? Int J Radiat Oncol Biol Phys 2006;64:63-71.
5 Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: Phase III randomized intergroup study 0099. J Clin Oncol 1998;16:1310-7.
6 Lee N, Harris J, Garden AS, Straube W, Glisson B, Xia P, et al. Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: Radiation therapy oncology group phase II trial 0225. J Clin Oncol 2009;27:3684-90.
7 Chan AT, Teo PM, Ngan RK, Leung TW, Lau WH, Zee B, et al. 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;20:2038-44.
8 Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: A meta-analysis of the published literature. J Clin Oncol 2004;22:4604-12.
9 Ma J, Mai HQ, Hong MH, Min HQ, Mao ZD, Cui NJ, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol 2001;19:1350-7.
10 International Nasopharynx Cancer Study Group, VUMCA I Trial. Preliminary results of a randomized trial comparing neoadjuvant chemotherapy (cisplatin, epirubicin, bleomycin) plus radiotherapy vs. radiotherapy alone in stage IV(>or = N2, M0) undifferentiated nasopharyngeal carcinoma: A positive effect on progression-free survival. Int J Radiat Oncol Biol Phys 1996;35:463-9.
11 Hong S, Wu HG, Chie EK, Bang YJ, Heo DS, Kim KH, et al. Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1999;45:901-5.
12 Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: A phase 3, multicentre, randomised controlled trial. Lancet Oncol 2016;17:1509-20.
13 Cao SM, Yang Q, Guo L, Mai HQ, Mo HY, Cao KJ, et al. 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;75:14-23.
14 Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, et al. 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;13:163-71.
15 Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, et al. Adjuvant chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: Long-term results of a phase 3 multicentre randomised controlled trial. Eur J Cancer 2017;75:150-8.
16 Lee AW, Ma BB, Ng WT, Chan AT. Management of nasopharyngeal carcinoma: Current practice and future perspective. J Clin Oncol 2015;33:3356-64.
17 Zhang L, Huang Y, Hong S, Yang Y, Yu G, Jia J, et al. Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma: A multicentre, randomised, open-label, phase 3 trial. Lancet 2016;388:1883-92.
18 Bogart E, Jouin A, Béhal H, Duhamel A, Filleron T, Kramar A, et al. Analysis of survival adjusted for quality of life using the Q-TWiST function: Interface in R. Comput Methods Programs Biomed 2016;125:79-87.
19 Foo KF, Tan EH, Leong SS, Wee JT, Tan T, Fong KW, et al. Gemcitabine in metastatic nasopharyngeal carcinoma of the undifferentiated type. Ann Oncol 2002;13:150-6.
20 Ma BB, Tannock IF, Pond GR, Edmonds MR, Siu LL. Chemotherapy with gemcitabine-containing regimens for locally recurrent or metastatic nasopharyngeal carcinoma. Cancer 2002;95:2516-23.
21 Ngeow J, Lim WT, Leong SS, Ang MK, Toh CK, Gao F, et al. Docetaxel is effective in heavily pretreated patients with disseminated nasopharyngeal carcinoma. Ann Oncol 2011;22:718-22.
22 Siu LL, Czaykowski PM, Tannock IF. Phase I/II study of the CAPABLE regimen for patients with poorly differentiated carcinoma of the nasopharynx. J Clin Oncol 1998;16:2514-21.
23 Hasbini A, Mahjoubi R, Fandi A, Chouaki N, Taamma A, Lianes P, et al. Phase II trial combining mitomycin with 5-fluorouracil, epirubicin, and cisplatin in recurrent and metastatic undifferentiated carcinoma of nasopharyngeal type. Ann Oncol 1999;10:421-5.
24 Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, et al. Head and neck cancers, version 1.2015. J Natl Compr Canc Netw 2015;13:847-55.
25 Sun X, Su S, Chen C, Han F, Zhao C, Xiao W, et al. Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: An analysis of survival and treatment toxicities. Radiother Oncol 2014;110:398-403.
26 Huang CJ, Leung SW, Lian SL, Wang CJ, Fang FM, Ho YH, et al. Patterns of distant metastases in nasopharyngeal carcinoma. Kaohsiung J Med Sci 1996;12:229-34.
27 Sellers LM. Cancer of the nasopharynx: Its natural history and treatment. Arch Otolaryngol 1961;74:714-5.
28 Thanarajasingam G, Atherton PJ, Novotny PJ, Loprinzi CL, Sloan JA, Grothey A, et al. Longitudinal adverse event assessment in oncology clinical trials: The toxicity over time (ToxT) analysis of alliance trials NCCTG N9741 and 979254. Lancet Oncol 2016;17:663-70.
29 Cabarrou B, Boher JM, Bogart E, Tresch-Bruneel E, Penel N, Ravaud A, et al. How to report toxicity associated with targeted therapies? Ann Oncol 2016;27:1633-8.
30 Chua DT, Yiu HH, Seetalarom K, Ng AW, Kurnianda J, Shotelersuk K, et al. Phase II trial of capecitabine plus cisplatin as first-line therapy in patients with metastatic nasopharyngeal cancer. Head Neck 2012;34:1225-30.
31 Wu C, Wang WY, Twu CW, Lin PJ, Liu YC, Lin JC. Maintenance metronomic chemotherapy for recurrent/metastatic nasopharyngeal carcinoma. ESTRO 2016;119 Suppl 1:S515.