There is increasing evidence showing that concurrent chemoradiotherapy (CCRT) may be inadequate for patients with locoregionally advanced nasopharyngeal carcinoma. Until now, no randomized controlled clinical trial has proved the effectiveness of cetuximab plus CCRT.
There were 681 consecutive stage III-IVB NPC were included in this retrospective study.75 underwent CCRT with cetuximab and 606 received CCRT.The nasopharyngeal and neck tumor of all patients were treated by intensity modulation radiated therapy (IMRT).
After matching at a 1:2 ratio, 150 patients were treated with CCRT and 75 with CCRT plus C were selected. The 3-year PFS rates (83.7% vs 72.0%, P = 0.036) and 3-year LRFS rates (98.6% vs 90.2%, P = 0.034) were higher for patients in the CCRT plus C arm than with CCRT alone. Furthermore, a marginal trend of increasing risk of 3-year DMFS rates (83.9% vs 78.4%, P = 0.301) and 3-year OS rates (91.2% vs 85.8%, P = 0.123) was found. The results indicated that CCRT plus C treatment was a significant and independent protective predictor for 3-year PFS (P = 0.015) and LRFS rates(P = 0.047). When focusing on stage T4 and/or N3 in the subgroup, the CCRT plus C arm achieved significantly prolonged 3-year PFS (79.9% vs 62.6%, P = 0.022) and a marginally increased OS (88.0% vs 77.9%, P = 0.086) compared with that of CCRT alone. Additionally, the 3-year LRFS (97.0% vs 90.9%, P = 0.246) and DMFS (79.9% vs 67.8%, P = 0.161) were enhanced in patients with CCRT plus C compared to CCRT alone. When concentrating on stage III patients, there were no considerable statistically significant differences found in 3-year PFS, OS, LRFS, and DMFS rates between patients with and without cetuximab. No significant difference was observed in the late toxicities between the two treatments.
This propensity-matched study reveals that patients with T4 and/or N3 stage could benefit from the combination of cetuximab with the current chemoradiotherapy in locoregionally advanced NPC, although with more acute moderate to severe toxicities. However, this strategy remains to be validated in a prospective randomized controlled study.
Clinical trial identification
This retrospective study has no clinical trial identification.
Legal entity responsible for the study
Department of Radiation Oncology Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research
The National Natural Science Foundation of China (No. 81672989); Jiangsu Clinical Medicine Science and Technology Special Fund (BL2014091); Jiangsu Provincial Commission of Health and Family Planning Youth Research Project (Q201601).
All authors have declared no conflicts of interest.