Induction Chemotherapy (CT) with Docetaxel, Cisplatin, and Fluorouracil (TPF) Followed by Concomitant Cisplatin Plus Radiotherapy in Locally Advanced Nasopharyngeal Cancer (NPC) Results after 03 Years

ABSTRACT Backround in squamous cell carcinoma of head and neck cancer,TPF induction CT improved survival over cisplatin and fluorouracil (MR POSNER NEJM, vol 357 oct 2007 ). The main objectif of this study is to evaluate the activity and safety of TPF in patients (pts) with locally advanced NPC followed by concomitant cisplatin plus radiotherapy (cCTRT). Methods pts with undifferenciated NPC were enrolled from December 2006 to December 2010, and received 3 cycles of TPF (docetaxel 75mg/m2 day, and cisplatin 75mg/m2 day 1, plus fluorouracil 750 mg/M2 days 1-5, every 4 wks) with G-CSF days 1-5 post CT. Induction CT was follwed by cCTRT with cisplatin 40 mg/m2/wk and radiotherapy (65-70 gy) starting 4-6 wks after the third cycle of induction CT. The primary endpoint was overall response rate (ORR) after induction CT and after cCTRT. Secondary end points were toxicity, disease free survival (DFS), and overall survival (OS). Results Fourty-two (42) pts with locally advanced NPC have been enrolled (26M/16F). UICC 1997 classification: n = 9 stage II, n = 10 stage III, n= 23 stage IV (n = 10 IVA; n = 11 IVB). Median age is 37 yrs (range 18-64). Evocative clinical signs are cervical nodes n = 20, rhinologic n = 13, otologic n = 5, and neurologic n = 4. All pts were evaluated for safety and 38 for response. TPF was well tolerated with main toxicities grade 3-4 (WHO) consisting of neutropenia 36%, thrombocytopenia 23%, anemia 18%, diarrhea 6%,and mucositis 18%. Four pts died from sepsis that was probably treatment-related. ORR was 90% with 71,4% (n = 27) complete response (CR) rate, 23,6% (n = 9) partial response (PR), and 5,2% (n = 2) stable disease. No pts progressed after induction CT. Main toxicity during cCTRT was neutropenia grade 3-4 in 9%, mucositis grade 3 in 45% and grade 4 in 4%. Late toxicities were xerostomia grade 3 in 50%. At treatment completion, CR and PR rates were 79% and 20%; 2 pts had stable disease. At a median follow up of 36 months (7-48), 5% of pts have shown recurrence or progressive disease. DFS and OS rates at 36 months were 70% and 75%, respectively. Conclusion TPF followed by cCTRT appears to be an active and feasible regimen with an acceptable tolerability profile and may be a promising therapeutic option for pts with high stage NPC. Disclosure All authors have declared no conflicts of interest.