Familial Nasopharyngeal Carcinoma 6

190 A. W. M. LeeLR-FFR was slightly higher in the cisplatinGEMGroup (85% vs. 76%, p = 0.310), no improvements inD-FFR (78% vs. 83%, p = 0.310) and OS (70% vs. 85%,p = 0.310) were achieved. It seemed that this regimenis likely to be equally effective, but not superior to thecisplatin/FU regimen.A randomized Phase II trial (Hui et al. 2009) compareda regimen with two cycles of cisplatin (75 mg/m 2 ) in combination with docetaxel as induction chemotherapyfollowed by cisplatin (40 mg/m 2 ) weeklyin concurrence with RT vs. concurrent CRT alone onpatients with stage III–IVB disease. They showedthat the 34 patients treated by induction–concurrentCRT achieved significantly higher OS (94% vs. 68%;p = 0.012) than the 31 patients treated by concurrentCRT alone, though the improvement in EFS did notreach statistical significance (88% vs. 60%; p = 0.12).This induction regimen incurred Grade 3–4 neutropeniain 97% of patients, the rate of febrile neutropeniawas 12%, but no treatment-related death occurred.There were no significant differences in quality of lifeand late toxicities between the two treatment arms.14.5Ongoing Clinical TrialsInduction–concurrent CRT is hence a promisingstrategy for improving tumor control and furtherconfirmation is warranted. There are two ongoingrandomized trials to evaluate this important strategyfor patients with nonkeratinizing NPC.The NPC-0501 Trial by the Hong Kong NasopharyngealCancer Study Group focuses on patients withstage III–IVB disease. The standard arm is theIntergroup 0099 regimen using concurrent cisplatinplus adjuvant cisplatin/FU with RT at conventionalfractionation. The aims are to compare the therapeuticbenefits achieved by changing the chemotherapysequence from concurrent–adjuvant to induction–concurrent and changing the RT schedule from conventionalto accelerated fractionation. In addition,this trial attempts to study the possibility of replacingFU with the oral pro-drug capecitabine (XE).Eligible patients are randomly assigned to:Arm 1A: Concurrent cisplatin plus adjuvant cisplatin/FUwith RT at conventional fractionation;Arm 1B: Concurrent cisplatin plus adjuvant cisplatin/FUwith RT at accelerated fractionation;Arm 2A: Induction cisplatin/FU plus concurrent cisplatinwith RT at conventional fractionation;Arm 2B: Induction cisplatin/FU plus concurrent cisplatinwith RT at accelerated fractionation;Arm 3A: Induction cisplatin/XE plus concurrent cisplatinwith RT at conventional fractionation;Arm 3B: Induction cisplatin/XE plus concurrent cisplatinwith RT at accelerated fractionationThe primary endpoints for evaluation of treatmentefficacy include EFS (both preliminary andfinal reports) and OS (final report). Secondary endpointsinclude evaluation of acute and late toxicities.The GORTEC-NPC2006 Trial by Groupe OncologieRadiothérapie Tête et Cou focuses on patients withstage II–IVB disease. The standard arm is cisplatin(40 mg/m 2 ) weekly in concurrence with radiation atconventional fractionation. The aim is to comparethe therapeutic benefits achieved by adding cisplatin(75 mg/m²) in combination with docetaxel and FU(TPF regimen) as induction chemotherapy.Eligible patients are randomly assigned to:Arm 1: Concurrent cisplatin alone (40 mg/m2)weekly during 7 weeks of RT;Arm 2: Induction chemotherapy using TPF regimenplus concurrent cisplatin.The main endpoint is the EFS.14.6SummaryNasopharyngeal carcinoma is a chemo sensitivemalignancy, and systemic chemotherapy plays animportant role in the management of nonmetastaticdisease. Induction chemotherapy per se using cisplatin-basedregimen with adequate dosage can achievemodest but significant improvement in tumor control.Adding induction chemotherapy to concurrentchemoradiation therapy is a promising strategy forNPC; however, confirmation for such strategy by randomizedtrials is awaited. Optimal balance of costeffectivenessand toxicities is important, and moreaccurate prognostication for better tailoring of treatmentstrategy for individual patient is vital.ReferencesAl-Amro A, Al-Rajhi N, Khafaga Y, et al (2005) Neoadjuvantchemotherapy followed by concurrent chemo-radiationtherapy in locally advanced nasopharyngeal carcinoma.Int J Radiat Oncol Biol Phys 62:508–513