Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients receiving additional induction chemotherapy.
To clarify the optimal cumulative cisplatin dose (CCD) in locoregionally-advanced nasopharyngel carcinoma (NPC) patients receiving induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT). Using the NPC-specific database from the established big-data intelligence platform at Sun Yat-Sen University Cancer Center, 583 non-disseminated, locoregionally-advanced NPC patients receiving IC plus CCRT were enrolled. Propensity score matching (PSM) analysis was conducted to control for confounding factors. The median CCD was 160 mg/m2 after IC (range, 40-300 mg/m2 ); only 74 patients (12.7%) achieved CCD >200 mg/m2 . Patients receiving >200 mg/m2 CCD did not show significantly improved 5-year overall survival (OS) (HR = 1.19; 95% confidence intervals [CI] 0.69-2.06, P = .53) and progression-free survival (PFS) (HR = 1.03; 95% CI: 0.63-1.68, P = .92) compared with patients receiving <200 mg/m2 CCD. Further investigations of the potential of median CCD (160 mg/m2 ) to yield survival benefits revealed that there were no significant differences in survival endpoints between patients receiving CCD >160 mg/m2 and CCD < 160 mg/m2 in both the original and PSM cohorts. In addition, subgroup analysis indicated a favorable PFS, but not OS, with higher cisplatin administration in patients with pretreatment Epstein-Barr virus deoxyribonucleic acid (EBV DNA) <1000 copies/mL (HR = 0.26, 95% CI: 0.07-0.93, P = .03) and receiving <3 IC cycles (HR = 0.59, 95% CI 0.33-1.07, P = .08). Our analysis of real world data provided references for the optimal CCD in locoregionally-advanced NPC receiving additional IC. The causal relationship between 200 mg/m2 CCD and improved survival was not defined; 160 mg/m2 CCD might be enough. However, for patients with EBV DNA <1000 copy/mL and receiving <3 IC cycles, a higher dose might be necessary.
['Lv|Jia-Wei|JW|', 'Qi|Zhen-Yu|ZY|', 'Zhou|Guan-Qun|GQ|', 'He|Xiao-Jun|XJ|', 'Chen|Yu-Pei|YP|', 'Mao|Yan-Ping|YP|', 'Chen|Lei|L|', 'Tang|Ling-Long|LL|', 'Li|Wen-Fei|WF|', 'Lin|Ai-Hua|AH|', 'Ma|Jun|J|', 'Sun|Ying|Y|http://orcid.org/0000-0002-5888-2929']
D000328:Adult D000368:Aged D000970:Antineoplastic Agents D002277:Carcinoma D059248:Chemoradiotherapy D002945:Cisplatin D016208:Databases, Factual D018572:Disease-Free Survival D004305:Dose-Response Relationship, Drug D020031:Epstein-Barr Virus Infections D005260:Female D004854:Herpesvirus 4, Human D006801:Humans D060828:Induction Chemotherapy D008297:Male D008875:Middle Aged D000077274:Nasopharyngeal Carcinoma D009303:Nasopharyngeal Neoplasms D016896:Treatment Outcome D055815:Young Adult
cumulative cisplatin dose nasopharyngeal carcinoma induction chemotherapy real world data intensity-modulated radiation therapy