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Chan ATC, Lee VHF, Hong RL, Ahn MJ, Chong WQ, Kim SB, Ho GF, Caguioa PB, Ngamphaiboon N, Ho C, Aziz MASA, Ng QS, Yen CJ, Soparattanapaisarn N, Ngan RKC, Kho SK, Tiambeng MLA, Yun T, Sriuranpong V, Algazi AP, Cheng A, Massarelli E, Swaby RF, Saraf S, Yuan J, Siu LL. Pembrolizumab monotherapy versus chemotherapy in platinum-pretreated, recurrent or metastatic nasopharyngeal cancer (KEYNOTE-122): an open-label, randomized, phase III trial. Ann Oncol 2023; 34:251-261. [PMID: 36535566 DOI: 10.1016/j.annonc.2022.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pembrolizumab previously demonstrated robust antitumor activity and manageable safety in a phase Ib study of patients with heavily pretreated, programmed death ligand 1 (PD-L1)-positive, recurrent or metastatic nasopharyngeal carcinoma (NPC). The phase III KEYNOTE-122 study was conducted to further evaluate pembrolizumab versus chemotherapy in patients with platinum-pretreated, recurrent and/or metastatic NPC. Final analysis results are presented. PATIENTS AND METHODS KEYNOTE-122 was an open-label, randomized study conducted at 29 sites, globally. Participants with platinum-pretreated recurrent and/or metastatic NPC were randomly assigned (1 : 1) to pembrolizumab or chemotherapy with capecitabine, gemcitabine, or docetaxel. Randomization was stratified by liver metastasis (present versus absent). The primary endpoint was overall survival (OS), analyzed in the intention-to-treat population using the stratified log-rank test (superiority threshold, one-sided P = 0.0187). Safety was assessed in the as-treated population. RESULTS Between 5 May 2016 and 28 May 2018, 233 participants were randomly assigned to treatment (pembrolizumab, n = 117; chemotherapy, n = 116); Most participants (86.7%) received study treatment in the second-line or later setting. Median time from randomization to data cut-off (30 November 2020) was 45.1 months (interquartile range, 39.0-48.8 months). Median OS was 17.2 months [95% confidence interval (CI) 11.7-22.9 months] with pembrolizumab and 15.3 months (95% CI 10.9-18.1 months) with chemotherapy [hazard ratio, 0.90 (95% CI 0.67-1.19; P = 0.2262)]. Grade 3-5 treatment-related adverse events occurred in 12 of 116 participants (10.3%) with pembrolizumab and 49 of 112 participants (43.8%) with chemotherapy. Three treatment-related deaths occurred: 1 participant (0.9%) with pembrolizumab (pneumonitis) and 2 (1.8%) with chemotherapy (pneumonia, intracranial hemorrhage). CONCLUSION Pembrolizumab did not significantly improve OS compared with chemotherapy in participants with platinum-pretreated recurrent and/or metastatic NPC but did have manageable safety and a lower incidence of treatment-related adverse events.
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Affiliation(s)
- A T C Chan
- State Key Laboratory in Translational Oncology, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong, China.
| | - V H F Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - R-L Hong
- National Taiwan University Hospital, Taipei, Taiwan
| | - M-J Ahn
- Samsung Medical Centre, Seoul, South Korea
| | - W Q Chong
- National University Cancer Institute, Singapore, Singapore
| | - S-B Kim
- Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - G F Ho
- Clinical Oncology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - P B Caguioa
- St. Luke's Medical Center, University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | - N Ngamphaiboon
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - C Ho
- BC Cancer, University of British Columbia, Vancouver, Canada
| | - M A S A Aziz
- Gleneagles Penang Clinical Research Center, Gleneagles Hospital Penang, Penang, Malaysia
| | - Q S Ng
- National Cancer Centre Singapore, Singapore, Singapore
| | - C-J Yen
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - R K-C Ngan
- Queen Elizabeth Hospital, Kowloon, Hong Kong, China
| | - S K Kho
- Hospital Umum Sarawak, Kuching, Malaysia
| | - M L A Tiambeng
- Cardinal Santos Medical Center, San Juan City, Philippines
| | - T Yun
- National Cancer Center, Goyang-si, South Korea
| | - V Sriuranpong
- Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - A Cheng
- Princess Margaret Hospital, Hong Kong, China
| | - E Massarelli
- City of Hope Comprehensive Cancer Center, Duarte, USA
| | | | - S Saraf
- Merck & Co., Inc., Rahway, USA
| | - J Yuan
- Merck & Co., Inc., Rahway, USA
| | - L L Siu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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Chung HS, Chow JCH, Lam MHC, Ngan RKC, Wong KH. Clinicopathological Features, Prognostic Factors, and Treatment Outcomes in Non-metastatic Breast Cancer in Young Asian Women in Hong Kong. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- HS Chung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - JCH Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - MHC Lam
- Department of Oncology, United Christian Hospital, Hong Kong
| | - RKC Ngan
- Department of Clinical Oncology, Gleneagles Hospital Hong Kong, Hong Kong
| | - KH Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
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Co M, Ngan RKC, Mang OWK, Tam AHP, Wong KH, Kwong A. Clinical outcomes of patients with ductal carcinoma in situ in Hong Kong: 10-year territory-wide cancer registry study. Hong Kong Med J 2020; 26:486-491. [PMID: 33277445 DOI: 10.12809/hkmj198203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Incidence of ductal carcinoma in situ (DCIS) has increased in recent decades because of breast cancer screening. This study comprised a long-term survival analysis of DCIS using 10-year territory-wide data from the Hong Kong Cancer Registry. METHODS This study included all patients diagnosed with DCIS in Hong Kong from 1997 to 2006. Exclusion criteria were age <30 years or ≥70 years, lobular carcinoma in situ, Paget's disease, and co-existing invasive carcinoma. Patients were stratified into those diagnosed from 1997 to 2001 and those diagnosed from 2002 to 2006. The 5- and 10-year breast cancer-specific survival rates were evaluated; standardised mortality ratios were calculated. RESULTS Among the 1391 patients in this study, 449 were diagnosed from 1997 to 2001, and 942 were diagnosed from 2002 to 2006. The mean age at diagnosis was 49.2±9.2 years. Overall, 51.2% of patients underwent mastectomy and 29.5% received adjuvant radiotherapy. The median follow-up interval was 11.6 years; overall breast cancer-specific mortality rates were 0.3% and 0.9% after 5 and 10 years of follow-up, respectively. In total, 109 patients (7.8%) developed invasive breast cancer after a considerable delay. Invasive breast cancer rates were comparable between patients diagnosed from 1997 to 2001 (n=37, 8.2%) and those diagnosed from 2002 to 2006 (n=72, 7.6%). CONCLUSION Despite excellent long-term survival among patients with DCIS, these patients were more likely to die of breast cancer, compared with the general population of women in Hong Kong.
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Affiliation(s)
- M Co
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Hong Kong.,Department of Surgery, Queen Mary Hospital, Hong Kong
| | - R K C Ngan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong.,Hong Kong Cancer Registry, Hospital Authority, Hong Kong.,Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - O W K Mang
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - A H P Tam
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong
| | - K H Wong
- Hong Kong Cancer Registry, Hospital Authority, Hong Kong.,Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - A Kwong
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Hong Kong.,Department of Surgery, Queen Mary Hospital, Hong Kong
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Lee TY, Lam MHC, Cheung KM, Cheng HC, Ngan RKC, Wong KH. Gemcitabine Plus Nanoparticle Albumin-bound Paclitaxel for Patients with Inoperable Pancreatic Cancer: Experience at a Single Oncology Centre. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- TY Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - MHC Lam
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - KM Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - HC Cheng
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - RKC Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - KH Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
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Ho WK, Ngan RKC, Yip CWY, Lee FKH, Lui JCF. Breast Cancer Patients Treated by Helical Tomotherapy, Intensity-modulated Radiotherapy, and Volumetric Arc Therapy: Comparison of Lung Doses. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2016959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- WK Ho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - RKC Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - CWY Yip
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - FKH Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - JCF Lui
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
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Cheung KM, Ngan RKC, Chow JCH, Lee TY, Li KWS, Cheng HC, Leung CWL, Yiu HHY, Yau S, Au JSK, Wong KH. Can Neoadjuvant Chemotherapy before Definitive Surgery Improve Outcome in Operable Stage IVA Oral Cavity Cancers? Hong Kong J Radiol 2018. [DOI: 10.12809/hkjr1816962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lam MHC, Cheuk W, Au Yong TK, Cheng HC, Ngan RKC. Pancreatic Neuroendocrine Tumours. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chan JCH, Leung AKC, Fong ST, Chiu HM, Ngan RKC. Management of Chordoma in a Tertiary Hospital in Hong Kong. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ngan RKC. Women’s Imaging and Oncology. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1616445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lee TY, Chan ACL, Ngan RKC. Recurrent Pigmented Villonodular Synovitis with Distant Metastases: Case Report and Review of the Literature on the Efficacy of Targeted Therapies. Hong Kong J Radiol 2016. [DOI: 10.12809/hkjr1615343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tai YP, Ngan RKC, Ting SH. Coexistence of Two Epstein-Barr Virus–associated Malignancies: Lymphoepithelioma-like Cholangiocarcinoma in a Patient with a History of Undifferentiated Nasopharyngeal Carcinoma. Hong Kong J Radiol 2015. [DOI: 10.12809/hkjr1514280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chong HM, Lo PY, Ngan RKC. Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma. Hong Kong J Radiol 2015. [DOI: 10.12809/hkjr1414247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lee HL, Ho WY, Lam YL, Ng TP, Li KH, Shek T, Mak KL, Fong ST, So YC, Ngan RKC, Lau PPL, Chan ACL. Prognostic factors associated with clear cell sarcoma in 14 Chinese patients. J Orthop Surg (Hong Kong) 2014; 22:236-9. [PMID: 25163964 DOI: 10.1177/230949901402200226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE. To identify prognostic factors associated with clear cell sarcomas in 14 Chinese patients. METHODS. Medical records of 7 men and 7 women (mean age, 36 years) with histologically confirmed clear cell sarcoma of tendons and aponeuroses were reviewed. Patient demographics, tumour characteristics, and treatment modalities were retrieved. Prognostic factors associated with favourable 5-year survival were determined. RESULTS. The most affected sites were the thigh (n=5) and the foot (n=4); the mean time from symptom onset to diagnosis was 9.5 months. The tumour stage at diagnosis was IIA in 8 patients, IIB in 2, and III in 4. The mean tumour size was 4.5 cm in diameter. One patient was lost to follow-up. For the remaining 13 patients, the mean time to disease-related mortality was 2.5 years. Nine patients had distant metastases; the most common sites were lungs and pleura (n=7), followed by distant lymph nodes (n=4), bone (n=2), pericardium (n=2), and brain (n=1). All patients underwent surgical excision. Three women and one man (mean age, 27 years) attained 5-year disease-free survival. All had stage IIA tumours at diagnosis. Their mean tumour size was 1.75 cm in diameter, which was significantly smaller than that of all patients (4.5 cm). Tumour size of ≤ 2.5 cm in diameter (p=0.004) and stage IIA tumour at diagnosis (p=0.04) were significant prognostic factors for 5-year survival. CONCLUSION. Tumour size of ≤ 2.5 cm and early stage tumour are associated with 5-year disease-free survival. Early detection is crucial for the prognosis of clear cell sarcomas.
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Affiliation(s)
- H L Lee
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - W Y Ho
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - Y L Lam
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - T P Ng
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - K H Li
- Department of Surgery, Queen Mary Hospital, Hong Kong
| | - T Shek
- Department of Pathology, Queen Mary Hospital, Hong Kong
| | - K L Mak
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| | - S T Fong
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| | - Y C So
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| | - R K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - P P L Lau
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong
| | - A C L Chan
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong
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Ngan RKC, Wong RKY, Tang FNF, Tang DLC. Curative radiotherapy for early cancers of the lip, buccal mucosa, and nose--a simple interstitial brachytherapy technique employing angiocatheters as carriers for Iridium-192 wire implants. Hong Kong Med J 2005; 11:351-9. [PMID: 16219954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES To evaluate treatment outcomes following interstitial brachytherapy for cancers of the lip, buccal mucosa, or nose. DESIGN Retrospective study. SETTING Regional hospital, Hong Kong. PATIENTS A cohort of 13 patients treated uniformly by a simple interstitial brachytherapy technique employing plastic angiocatheters as carriers for Iridium-192 wires: all but one patient had T1 or T2 tumours and all but one had N0 disease. MAIN OUTCOME MEASURES Local and loco-regional control rates. RESULTS Six of the 13 patients received external radiotherapy prior to interstitial brachytherapy. A median brachytherapy dose of 70 Gy was delivered to those treated with brachytherapy alone, while 35 Gy was delivered after a median external radiotherapy dose of 50 Gy to those receiving combined treatment. The 3-year actuarial local control rate was 75%. No significant late complications were observed. CONCLUSIONS Employing a simple brachytherapy technique using angiocatheters and Iridium-192 wires, in conjunction with external radiotherapy when appropriate, produces good outcomes for patients with early lip, nasal vestibule, and buccal mucosa cancers.
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Affiliation(s)
- R K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong.
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Ngan RKC, Yiu HHY, Lau WH, Yau S, Cheung FY, Chan TM, Kwok CH, Chiu CY, Au SK, Foo W, Law CK, Tse KC. Combination gemcitabine and cisplatin chemotherapy for metastatic or recurrent nasopharyngeal carcinoma: report of a phase II study. Ann Oncol 2002; 13:1252-8. [PMID: 12181249 DOI: 10.1093/annonc/mdf200] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and toxicity of combination gemcitabine plus cisplatin (GC) chemotherapy in metastatic or recurrent nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS Forty-four patients of Chinese ethnicity with metastatic or recurrent NPC received ambulatory GC chemotherapy every 28 days (gemcitabine 1000 mg/m(2) days 1, 8 and 15; cisplatin 50 mg/m(2) days 1 and 8). There were 40 male and four female patients with a mean age of 47.4 years. More than half (54.5%) of the patients had received either prior platinum-based chemotherapy and/or radiotherapy to target lesions. RESULTS There were nine complete responses and 23 partial responses in the 44 patients, achieving an overall response rate of 73% (78% for the 41 assessable patients). The mean duration of response was 5.3 months. Improved subjective symptom-control scores were found in 78% of patients with pre-existing symptoms, while 64% of patients experienced improved general well-being scores. Toxicity was mainly hematological: grade III/IV anemia, granulocytopenia and thrombocytopenia were found in 11, 37 and 16% of cycles, respectively. With a median follow-up of 17.2 months, 62% survived 1 year while 36% were alive and progression free. CONCLUSIONS Gemcitabine plus cisplatin chemotherapy offers a satisfactory overall response rate, subjective patient improvement and safety profile for metastatic and recurrent NPC.
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Affiliation(s)
- R K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong.
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