Comparison of therapeutic efficacy and toxicity of docetaxel, cisplatin, and fluorouracil (TPF)-based induction chemotherapy plus concurrent chemoradiotherapy and chemoradiotherapy alone in locally advanced nasopharyngeal carcinoma

Long-term results of locoregionally advanced nasopharyngeal carcinoma treated with cisplatin and 5-fluorouracil induction chemotherapy with or without docetaxel in young and middle aged adults

PURPOSE

This study aims to evaluate the efficacy and toxicity of the two induction chemotherapy (IC) regimens (TPF: docetaxel, cisplatin and 5-fluorouracil, and PF: cisplatin and 5-fluorouracil) combined with radiotherapy in young and middle aged patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).

METHODS

A retrospective analysis was conducted on 329 cases with stage III-IVA nasopharyngeal carcinoma from September 2005 to February 2017. Of the 329 cases, 253 cases underwent TPF (docetaxel: 60 mg/m2 on day 1, cisplatin: 25 mg/m2 on days 1-3, 5-fluorouracil: 500 mg/m2 on days 1-5, intravenous 120-h infusion), while 76 cases received the PF regimen (cisplatin: 25 mg/m2 on days 1-3, 5-fluorouracil: 500 mg/m2 on days 1-5, intravenous 120-h infusion) every 3 weeks. Radiotherapy was administered after IC with or without concurrent chemotherapy. The survival rates were assessed by Kaplan-Meier analysis, and the survival curves were compared using a log‑rank test.

RESULTS

The 5-year and 8-year overall survival (OS) rates of the PF group and TPF group were 80.1% and 72.1%, 87.3% and 78.4% respectively (p = 0.405). There were no statistical differences in regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) rates between PF and TPF groups(p = 0.585 and 0.500, respectively).The 5-year and 8-year estimated local recurrence free survival (LRFS) rates for patients in PF and TPF group were 91.1% and 78.0%, 96.2% and 93.7%, respectively (p = 0.026). Moreover, The OS, LRFS, RRFS and DMFS rates were comparable between the non CCRT or CCRT subgroup (p = 0.542, 0.319, 0.070, 0.986, respectively). Compared with PF group, the TPF group significantly increased the occurrence of grade 3 or 4 neutropenia and leukopenia (p < 0.001).

CONCLUSION

PF and TPF followed by radiotherapy with or without concurrent chemotherapy performed encouraging anti-tumor effects in LA-NPC, there was no statistical significance in 5-year and 8-year OS, RRFS, and DMFS rates between two chemotherapy regimens. Compared with PF, TPF induction chemotherapy achieved more satisfactory LRFS rate in LA-NPC with acceptable toxicity.

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.

Ganoderma spore lipid ameliorates docetaxel, cisplatin, and 5-fluorouracil chemotherapy-induced damage to bone marrow mesenchymal stem cells and hematopoiesis

BACKGROUND

A triplet chemotherapy regimen of docetaxel, cisplatin, and 5-fluorouracil (TPF) is used to treat head and neck squamous cell carcinoma; however, it is toxic to bone marrow mesenchymal stem cells (BMSCs). We previously demonstrated that Ganoderma spore lipid (GSL) protect BMSCs against cyclophosphamide toxicity. In this study, we investigated the protective effects of GSL against TPF-induced BMSCs and hematopoietic damage.

METHODS

BMSCs and C57BL/6 mice were divided into control, TPF, co-treatment (simultaneously treated with GSL and TPF for 2 days), and pre-treatment (treated with GSL for 7 days before 2 days of TPF treatment) groups. In vitro, morphology, phenotype, proliferation, senescence, apoptosis, reactive oxygen species (ROS), and differentiation of BMSCs were evaluated. In vivo, peripheral platelets (PLTs) and white blood cells (WBCs) from mouse venous blood were quantified. Bone marrow cells were isolated for hematopoietic colony-forming examination.

RESULTS

In vitro, GSL significantly alleviated TPF-induced damage to BMSCs compared with the TPF group, recovering their morphology, phenotype, proliferation, and differentiation capacity (p < 0.05). Annexin V/PI and senescence-associated β-galactosidase staining showed that GSL inhibited apoptosis and delayed senescence in TPF-treated BMSCs (p < 0.05). GSL downregulated the expression of caspase-3 and reduced ROS formation (p < 0.05). In vivo, GSL restored the number of peripheral PLTs and WBCs and protected the colony-forming capacity of bone marrow cells (p < 0.05).

CONCLUSIONS

GSL efficiently protected BMSCs from damage caused by TPF and recovered hematopoiesis.

Meta-analysis of efficacy of Chinese medicine compound combined with concurrent radiotherapy and chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma

BACKGROUND

Nasopharyngeal carcinoma is a prevalent malignant tumor in clinical practice, with the highest incidence rate among otorhinolaryngological malignant tumors.

OBJECTIVES

This study aims to comprehensively evaluate the clinical efficacy and safety of traditional Chinese medicine compound (CMC) combined with concurrent radiotherapy and chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma (LA-NPC).

METHODS

Relevant essays published before November 20, 2021, were retrieved from China National Knowledge Internet (CNKI), China Science and Technology Journal Database (CQVIP), Wanfang database, PubMed, and Web of Science databases. Randomized controlled trials regarding the clinical efficacy of CMC combined with concurrent radiotherapy and chemotherapy in the treatment of LA-NPC were included.

RESULTS

A total of 15 publications involving 1324 patients were included in this study, including 665 in the experimental group and 659 in the control group. Meta-analyses revealed that compared with radiotherapy or chemotherapy only, CMC combined with concurrent radiotherapy and chemotherapy for LA-NPC significantly improved the efficacy [risk ratio (RR)=1.15, 95% confidence interval (95% CI) (1.09, 1.20), P<0.00001], the quality of life [RR=1.35, 95% CI (1.13, 1.62), P=0.0009], immune function indices CD4+ levels [RR=6.2, 95% CI (3.64, 8.76), P<0.00001], CD4+/CD8+ [RR=0.33, 95% CI (0.14, 0.53), P=0.0009], and alleviated the decrease in white blood cell counts [RR=0.67, 95% CI (0.52, 0.86), P=0.002].

CONCLUSION

CMC combined with concurrent radiotherapy and chemotherapy for the treatment of LA-NPC can significantly improve the efficacy and reduce severe adverse reactions caused by conventional radiotherapy and chemotherapy. However, due to limitations in the quantity and quality of the included studies, more high-quality, multi-center, and large sample-size studies are needed to provide high-level and high-quality medical evidence for systematic evaluation.

Effects of CIK Cell Therapy Combined with Camrelizumab on the Quality of Life in Patients with Nasopharyngeal Carcinoma and Analysis of Prognostic Factors

Objective

To investigate the effects of CIK (cytokine-induced killer) cell therapy combined with camrelizumab on the quality of life in patients with nasopharyngeal carcinoma and prognostic factors.

Methods

In this retrospective study, the materials of 80 patients with nasopharyngeal carcinoma treated in our hospital (February 2017-February 2019) were retrospectively analyzed, and they were equalized into experimental group (n = 40) and control group (n = 40) according to the order of admission. Both groups received 200 mg of camrelizumab on day 1 combined with 10 mg of anrotinib from day 2 to day 4. The patients received the above program every 3 weeks and 4 treatment cycles. The experimental group also received CIK cell therapy simultaneously. The patients' quality of life, immune indexes, local control, metastasis, and survival rate were compared between the two groups, and the prognostic factors were analyzed by logistic analysis.

Results

Compared with the control group, the experimental group achieved much higher scores of physical well-being (18.38 ± 2.31), social/family well-being (16.40 ± 2.24), emotional well-being (15.35 ± 2.30), functional well-being (17.30 ± 2.20), and head and neck cancer subscale (15.40 ± 2.01, P < 0.001) and eminently better immune indexes (P < 0.001) after treatment. During the 24-month follow-up, there were 2 recurrent cases (5.0%) and 2 cases (5.0%) with distant metastasis among the 40 patients in the experimental group; there were 8 recurrent cases (20.0%) and 7 cases (17.5%) with distant metastasis among the 40 patients in the control group. In the experimental group, the median survival period was 18 months and the 2-year survival rate was 97.5% (39/40). In the control group, the median survival period was 14 months and the 2-year survival rate was 85.0% (34/40). Among the 80 patients, 7 cases (8.75%) died and 73 cases (91.25%) survived. After conducting the single-factor analysis, remarkable differences in the cases of IV stage, quality of life after treatment, and immune indexes after treatment between the survival group and the death group were observed (P < 0.05). According to the multiple-factor analysis, the clinical stage and immune indexes were identified as the prognostic factors.

Conclusion

CIK cell therapy combined with camrelizumab can enhance the life quality and immune function of the patients with nasopharyngeal carcinoma, thus improving their prognoses.