Comparison the Acute Toxicity of Two Different Induction Chemotherapy Schedules with Cisplatin and Fluorouracil in Nasopharyngeal Carcinoma Patients

Real-world data on the efficacy and toxicity of induction chemotherapy in locally advanced nasopharyngeal carcinoma in a non-endemic population

Background

Induction chemotherapy (ICT) is critical for managing locally advanced nasopharyngeal carcinoma (LA-NPC), but real-world data on its efficacy and toxicity are limited.

Methods

This retrospective study included LA-NPC patients treated with ICT from 2012 to 2022. We evaluated radiological response rates, overall survival (OS), treatment-related toxicities and complete response (CR) rates.

Results

Among 217 patients, 119 met the inclusion criteria and were included in the final analysis. CR rates were similar across ICT regimens (docetaxel, cisplatin and 5-fluorouracil 68.0%; cisplatin and gemcitabine 57.1%; cisplatin and 5-fluorouracil 58.0%; others 50%, p = 0.72). Serious adverse events (SAEs) occurred in 22%, with 69.7% experiencing weight loss and 31.9% requiring enteral tube placement. Poor OS was linked to Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥2 hazard ratios (HR 2.8, p = 0.004) and residual disease (RD) (HR 7.4, p = 0.001). Stage IV (Odds Ratio [OR] 3.77, p = 0.005) and ECOG-PS ≥ 2 (OR 4.69, p = 0.006) were associated with RD.

Conclusion

ICT regimens had similar CR rates. Poor ECOG-PS and stage IV predicted RD. Managing toxicities is crucial for better outcomes.

Research Progress of Disulfide Bond Based Tumor Microenvironment Targeted Drug Delivery System

Cancer poses a significant threat to human life and health. Chemotherapy is currently one of the effective cancer treatments, but many chemotherapy drugs have cell toxicity, low solubility, poor stability, a narrow therapeutic window, and unfavorable pharmacokinetic properties. To solve the above problems, target drug delivery to tumor cells, and reduce the side effects of drugs, an anti-tumor drug delivery system based on tumor microenvironment has become a focus of research in recent years. The construction of a reduction-sensitive nanomedicine delivery system based on disulfide bonds has attracted much attention. Disulfide bonds have good reductive responsiveness and can effectively target the high glutathione (GSH) levels in the tumor environment, enabling precise drug delivery. To further enhance targeting and accelerate drug release, disulfide bonds are often combined with pH-responsive nanocarriers and highly expressed ligands in tumor cells to construct drug delivery systems. Disulfide bonds can connect drug molecules and polymer molecules in the drug delivery system, as well as between different drug molecules and carrier molecules. This article summarized the drug delivery systems (DDS) that researchers have constructed in recent years based on disulfide bond drug delivery systems targeting the tumor microenvironment, disulfide bond cleavage-triggering conditions, various drug loading strategies, and carrier design. In this review, we also discuss the controlled release mechanisms and effects of these DDS and further discuss the clinical applicability of delivery systems based on disulfide bonds and the challenges faced in clinical translation.

Phase I dose-escalation study of nab-paclitaxel combined with cisplatin and capecitabin as induction chemotherapy followed by concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma

BACKGROUND AND PURPOSE

Nab-paclitaxel is a promising albumin-bound paclitaxel with a therapeutic index superior to that of docetaxel, but the optimal dose of nab-paclitaxel combined with cisplatin and capecitabine as induction chemotherapy followed by concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma remains unknown.

MATERIALS AND METHODS

This was an open-label, single-arm study investigating the safety and efficacy of nab-paclitaxel + cisplatin + capecitabin as IC for three cycles, followed by cisplatin CCRT, conducted by using the standard "3 + 3" design in LA-NPC. If more than one-third of the patients in a cohort experienced dose-limiting toxicity (DLT), the dose used in the previous cohort was designated the maximum tolerated dose (MTD). The recommended phase 2 dose (RP2D) was defined as one level below the MTD.

RESULTS

From 29 May 2021 to 17 March 2022, 19 patients with LA-NPC were enrolled, one patient withdrew informed consent. Two DLTs occurred in cohort 4 (grade 4 febrile neutropenia and grade 3 peripheral neuropathy), and an MTD was established as 225 mg/m2. The most frequent grade 3 or 4 adverse events were neutropenia (16.7 %), hypertriglyceridemia (16.7 %), leukopenia (5.6 %) and peripheral neuropathy (5.6 %) during IC.

CONCLUSION

The RP2D is nab-paclitaxel 200 mg/m2 on day 1, combined with cisplatin 75 mg/mg2 on day 1 and capecitabin1000 mg/m2 on days 1-14, twice a day, every 3 weeks, for three cycles as an IC regimen prior to CCRT.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04850235.