Previous study has reported taxane-based concurrent therapy had equivalent efficacy to platinum in head and neck squamous cell carcinom. However, studies about concurrent chemoradiation of docetaxel alone in NPC are limited.This study aimed to compare the effectiveness and toxicities of weekly docetaxel versus tri-weekly cisplatin concurrent chemoradiotherapy for locoregionally advanced NPC.
From January 2010 to December 2014, patients with newly diagnosed locoregionally advanced nasopharyngeal carcinoma receiving either weekly docetaxel or tri-weekly cisplatin were retrospectively reviewed. Propensity score matchingan alysis was used to balance baseline characteristics between treatment arms. Data from 962 patients were included in the analysis, and the propensity matched cohort included 448 patients in total.
The median follow-up duration is 47 months among the matched cohort.3-year nodal recurrence-free survival was significantly improved for patients treated with docetaxel compared to cisplatin (HR,0.33; 95%CI 0.12 to 0.90, P = 0.020), however,there were no differences in 3-year overall survival, local relapse-free survival, and distant-metastasis free survival between two groups. In subgroup analysis, cisplatin showed a trend towards improving distant metastasis free survival (89.2%vs.78.1%,P=0.075) which did not reach statistical significance in patients with pretreatment levels of Epstein-Barr VirusDNA≥4000 copy/mL. Significant higher incidence of grade 3/4 radiodermatitis (7.1%vs.1.6%,P=0.001) and mucositis (78.8%vs.45.5%,P<0.001)were observed in docetaxel group, but renal injury (1.8%vs. 15.1%, P < 0.01),vomiting(19.6% vs 93%, P < 0.01), hepatic injury (18.8%vs.31.3%,P<0.027), and grade 3/4 hematologicaltoxicity (2.2%vs.14.3%, P < 0.01) were more common in cisplatin group.
Weekly low-dose docetaxel concurrent chemoradiotherapyis an effective and toxicity tolerable method for locally advanced NPC.It provides a survival benefit mainly by improving regional control especially for patients with low EBV DNA levels. As forpatients with EBV DNA ≥4000 copy/mL, concurrent cisplatin seemsto be more efficacious.
Clinical trial identification
Legal entity responsible for the study
Sun Yat-sen University Cancer Center.
Has not received any funding.
The author has declared no conflicts of interest.