Is the gemcitabin-cisplatin combination the optimal induction chemotherapy for non-Asian patients with nasopharyngeal carcinoma (NPC)? Insights from a cohort in northeastern Morocco

TL;DR

A study in Morocco compared two chemotherapy regimens for nasopharyngeal cancer and found one to be more effective with acceptable side effects.

Contribution

The study provides insights into the effectiveness of doxorubicin-cisplatin versus gemcitabine-cisplatin in non-Asian NPC patients.

Findings

The DP regimen showed a higher partial response rate compared to GC.

GC had better 2-year overall survival but no significant survival difference between groups.

DP had less thrombocytopenia but more leukopenia and neutropenia compared to GC.

Abstract

According to the latest guidelines for nasopharyngeal carcinoma (NPC), induction chemotherapy (IC) followed by concomitant chemoradiation therapy is recommended as the preferred standard of care for patients with locally advanced NPC (stage III-IVA). However, the optimal regimen for IC in patients with locally advanced NPC remains uncertain.

We conducted a retrospective study to compare the effectiveness and tolerability of two platinum-based IC regimens; gemcitabine – Cisplatin (GC), and doxorubicin-Cisplatin (DP) in the treatment of newly diagnosed locally advanced NPC. The main objective of this study was to compare efficacy, including objective response rates (ORRs), progression-free survival (PFS), overall survival (OS) and safety.

105 patients were satisfied with the eligibility criteria and were, therefore, selected for analysis (62 patients in the DP group and 43 in the GC group), including 65 men and 40 women, with a mean age of 49.5 years (range = 19–79 years) and a Karnofsky score ranging from 87% to 100%. 34% of patients were diagnosed at stage IVA.

In the DP group, 3% of patients (2 out of 62) achieved a complete response complete response (CR), 60% achieved a partial response (PR), 25% remained stable S and 19% experienced progression. In the GC group, 2% of patients (1 out of 43) achieved a CR, 39.5% achieved a PR, 39.5% remained stable and 19% experienced progression. A statistically significant difference in PR was observed between the two groups (p = 0.028), and the difference in terms of progression is approaching the limit of significance (p = 0,06) after a median follow-up of 27 months (5.3–82). The 2-year PFS was 70% in the DP group compared to 80% in the GC group; the 2-year OS was 75% in the DP group and 90% in the GC group. No significant survival difference was observed between the two groups.

Patients in the DP group exhibited less grade 3–4 thrombocytopenia but more grade 3–4 leukopenia and neutropenia compared to the GC group.

In patients with locally advanced NPC, DP-based IC demonstrated superior ORR compared with the GC regimen, with acceptable toxicity. Further studies are required to validate these results.

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