Pediatric nasopharynx cancer: excellent outcomes with induction chemotherapy + CCRT

  • Rodriguez-Galindo C & al.
  • J Clin Oncol
  • 25 Sep 2019

  • curated by Craig Hicks
  • Univadis Clinical Summaries
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Takeaway

  • Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) results in excellent outcomes for pediatric patients with advanced nasopharyngeal cancer (NPC).
  • Radiation dose reduction is feasible for patients who respond to IC.

Why this matters

  • Treatments for childhood NPC are adapted from adult regimens because pediatric-specific studies are limited, say researchers.
  • All outcome endpoints, including event-free survival (EFS), OS, and locoregional and distant control, appear superior to those reported in adults.

Study design

  • Researchers studied pediatric patients with stage IIb-IV NPC (n=111; median age, 15 [range, 3-18] years; boys, 68%) treated with 3 cycles of IC with cisplatin and fluorouracil followed by CCRT with 2 or 3 cycles of cisplatin.
  • Children with complete/partial response to IC received 61.2 Gy to the nasopharynx and neck; those with stable disease received 71.2 Gy.
  • Funding: National Institutes of Health; St. Baldrick’s Foundation.

Key results

  • 5-year EFS and OS estimates were 84.3% and 89.2%, respectively.
  • 5-year EFS for stages IIb, III, and IV was 100%, 82.8%, and 82.7%, respectively.
  • 5-year cumulative incidence relapse estimates were 3.7% (local), 8.7% (distant), and 1.8% (combined).
  • Patients had better 5-year postinduction PFS when treated with 3 CCRT cycles (90.8%) vs 2 (81.1%; P=.14).

Limitations

  • Absence of control group.
  • Long-term toxicity not captured.