Effect of Concurrent Chemoradiotherapy With Nedaplatin vs Cisplatin on the Long-term Outcomes of Survival and Toxic Effects Among Patients With Stage II to IVB Nasopharyngeal Carcinoma: A 5-Year Follow-up Secondary Analysis of a Randomized Clinical Trial
Qing-Nan Tang, Li-Ting Liu, Bin Qi, Shan-Shan Guo, Dong-Hua Luo, Rui Sun, Xue-Song Sun, Dong-Ping Chen, Ling Guo, Hao-Yuan Mo, Pan Wang, Sai-Lan Liu, Yu-Jing Liang, Xiao-Yun Li, Zhen-Chong Yang, Qiu-Yan Chen, Hai-Qiang Mai, Lin-Quan Tang, Qing-Nan Tang, Li-Ting Liu, Bin Qi, Shan-Shan Guo, Dong-Hua Luo, Rui Sun, Xue-Song Sun, Dong-Ping Chen, Ling Guo, Hao-Yuan Mo, Pan Wang, Sai-Lan Liu, Yu-Jing Liang, Xiao-Yun Li, Zhen-Chong Yang, Qiu-Yan Chen, Hai-Qiang Mai, Lin-Quan Tang
Abstract
Importance: Nedaplatin-based concurrent chemoradiotherapy (CCRT) regimen at 2 years was noninferior to cisplatin-based regimen in patients with locoregional, stage II to IVB nasopharyngeal carcinoma (NPC) and was associated with fewer late adverse events, but longer-term outcomes and toxicity are unclear.
Objective: To evaluate the 5-year outcomes and late toxicity profile of nedaplatin-based CCRT in patients with locoregional, stage II to IVB NPC.
Design, settings, and participants: This 5-year follow-up secondary analysis of an open-label, noninferiority, multicenter randomized clinical trial enrolled patients with nonkeratinizing stage II to IVB NPC between January 16, 2012, and July 16, 2014, with a median follow-up duration of 78 months (IQR, 3-99 months). Data analysis was conducted from November 10, 2020, to July 8, 2021.
Interventions: Patients were randomly assigned (1:1) to receive nedaplatin (100 mg/m2)- or cisplatin (100 mg/m2)-based chemotherapy every 3 weeks for 3 cycles concurrently with intensity-modulated radiotherapy.
Main outcomes and measures: The primary end point was progression-free survival (PFS). Secondary end points were overall survival, distant metastasis-free survival, and locoregional relapse-free survival.
Results: A total of 402 eligible participants were enrolled (median [IQR] age, 45 [18-65] years; 302 [75.1%] male). Patients were randomly assigned to receive nedaplatin- or cisplatin-based CCRT (n = 201 for each): 196 patients (97.5%) started nedaplatin-based CCRT and 197 patients (98.0%) started cisplatin-based CCRT. Intention-to-treat analysis demonstrated a 5-year progression-free survival rate of 81.4% (95% CI, 75.9%-86.9%) for the cisplatin group and 79.8% (95% CI, 74.1%-85.5%) for nedaplatin group, with a difference of 1.6% (95% CI, -6.3% to 9.5%; P = .002 for noninferiority). No significant survival differences were observed between the cisplatin and nedaplatin groups for 5-year overall survival (89.4% vs 88.8%, P = .63), distant metastasis-free survival (85.9% vs 90.4%, P = .17), and locoregional relapse-free survival (92.6% vs 89.6%, P = .17) rates. The cisplatin group had a higher incidence of grade 3 and 4 auditory toxic effects than the nedaplatin group (35 [17.7%] vs 21 [10.5%], P = .04).
Conclusions and relevance: In this secondary analysis of a randomized clinical trial, long-term analysis confirmed that nedaplatin-based CCRT could be regarded as an alternative doublet treatment strategy to cisplatin-based CCRT in stage II to IVB NPC.
Trial registration: ClinicalTrials.gov Identifier: NCT01540136.
Conflict of interest statement
Conflict of Interest Disclosures: None reported.
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References
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492
- Chen Y-P, Chan ATC, Le Q-T, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Lancet. 2019;394(10192):64-80. doi:10.1016/S0140-6736(19)30956-0
- Cao SM, Simons MJ, Qian CN. The prevalence and prevention of nasopharyngeal carcinoma in China. Chin J Cancer. 2011;30(2):114-119. doi:10.5732/cjc.010.10377
- Lee AWM, Lin JC, Ng WT. Current management of nasopharyngeal cancer. Semin Radiat Oncol. 2012;22(3):233-244. doi:10.1016/j.semradonc.2012.03.008
- Pathmanathan R, Prasad U, Sadler R, Flynn K, Raab-Traub N. Clonal proliferations of cells infected with Epstein-Barr virus in preinvasive lesions related to nasopharyngeal carcinoma. N Engl J Med. 1995;333(11):693-698. doi:10.1056/NEJM199509143331103
- Blanchard P, Lee A, Marguet S, et al. ; MAC-NPC Collaborative Group . Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis. Lancet Oncol. 2015;16(6):645-655. doi:10.1016/S1470-2045(15)70126-9
- Chan AT, Teo PM, Ngan RK, et al. . Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol. 2002;20(8):2038-2044. doi:10.1200/JCO.2002.08.149
- Al-Sarraf M, LeBlanc M, Giri PG, et al. . Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998;16(4):1310-1317. doi:10.1200/JCO.1998.16.4.1310
- Liu LT, Tang LQ, Chen QY, et al. . The prognostic value of plasma Epstein-Barr viral DNA and tumor response to neoadjuvant chemotherapy in advanced-stage nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2015;93(4):862-869. doi:10.1016/j.ijrobp.2015.08.003
- Shukuya T, Yamanaka T, Seto T, et al. ; West Japan Oncology Group . Nedaplatin plus docetaxel versus cisplatin plus docetaxel for advanced or relapsed squamous cell carcinoma of the lung (WJOG5208L): a randomised, open-label, phase 3 trial. Lancet Oncol. 2015;16(16):1630-1638. doi:10.1016/S1470-2045(15)00305-8
- Lu S, Chen Z, Hu C, et al. . Nedaplatin plus docetaxel versus cisplatin plus docetaxel as first-line chemotherapy for advanced squamous cell carcinoma of the lung—a multicenter, open-label, randomized, phase III trial. J Thorac Oncol. 2018;13(11):1743-1749. doi:10.1016/j.jtho.2018.07.006
- Yin L, Wu J, Wu J, et al. . Radiosensitization effect of nedaplatin on nasopharyngeal carcinoma cells in different status of Epstein-Barr virus infection. Biomed Res Int. 2014;2014:713674. doi:10.1155/2014/713674
- Tang LQ, Lu TY, Li Y, et al. . Patterns of failure and survival trends of 720 patients with stage I nasopharyngeal carcinoma diagnosed from 1990-2012: a large-scale retrospective cohort study. J Cancer. 2018;9(7):1308-1317. doi:10.7150/jca.21009
- Tang C, Wu F, Wang R, et al. . Comparison between nedaplatin and cisplatin plus docetaxel combined with intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma: a multicenter randomized phase II clinical trial. Am J Cancer Res. 2016;6(9):2064-2075.
- Zheng J, Wang G, Yang GY, et al. . Induction chemotherapy with nedaplatin with 5-FU followed by intensity-modulated radiotherapy concurrent with chemotherapy for locoregionally advanced nasopharyngeal carcinoma. Jpn J Clin Oncol. 2010;40(5):425-431. doi:10.1093/jjco/hyp183
- Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. J Crit Care. 2005;20(2):187-191. doi:10.1016/j.jcrc.2005.04.005
- Tang LQ, Chen DP, Guo L, et al. . Concurrent chemoradiotherapy with nedaplatin versus cisplatin in stage II-IVB nasopharyngeal carcinoma: an open-label, non-inferiority, randomised phase 3 trial. Lancet Oncol. 2018;19(4):461-473. doi:10.1016/S1470-2045(18)30104-9
- Alberto ME, Lucas MFA, Pavelka M, Russo N. The second-generation anticancer drug nedaplatin: a theoretical investigation on the hydrolysis mechanism. J Phys Chem B. 2009;113(43):14473-14479. doi:10.1021/jp9056835
- Kawai Y, Taniuchi S, Okahara S, Nakamura M, Gemba M. Relationship between cisplatin or nedaplatin-induced nephrotoxicity and renal accumulation. Biol Pharm Bull. 2005;28(8):1385-1388. doi:10.1248/bpb.28.1385
- Kawarada Y, Miyazaki M, Itoh A, et al. . Incidence of and risk factors associated with nedaplatin-related hypersensitivity reactions. Int J Clin Oncol. 2017;22(3):593-599. doi:10.1007/s10147-017-1091-4
- Liu Z, Liu J, Li L, et al. . Inhibition of autophagy potentiated the antitumor effect of nedaplatin in cisplatin-resistant nasopharyngeal carcinoma cells. PLoS One. 2015;10(8):e0135236. doi:10.1371/journal.pone.0135236
- Ribassin-Majed L, Marguet S, Lee AWM, et al. . What is the best treatment of locally advanced nasopharyngeal carcinoma? an Individual Patient Data Network meta-analysis. J Clin Oncol. 2017;35(5):498-505. doi:10.1200/JCO.2016.67.4119
- Wee J, Tan EH, Tai BC, et al. . Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol. 2005;23(27):6730-6738. doi:10.1200/JCO.2005.16.790
- Riechelmann RP, Alex A, Cruz L, Bariani GM, Hoff PM. Non-inferiority cancer clinical trials: scope and purposes underlying their design. Ann Oncol. 2013;24(7):1942-1947. doi:10.1093/annonc/mdt073
- Pong S, Urner M, Fowler RA, et al. . Testing for non-inferior mortality: a systematic review of non-inferiority margin sizes and trial characteristics. BMJ Open. 2021;11(4):e044480. doi:10.1136/bmjopen-2020-044480
- Lv X, Cao X, Xia WX, et al. . Induction chemotherapy with lobaplatin and fluorouracil versus cisplatin and fluorouracil followed by chemoradiotherapy in patients with stage III-IVB nasopharyngeal carcinoma: an open-label, non-inferiority, randomised, controlled, phase 3 trial. Lancet Oncol. 2021;22(5):716-726. doi:10.1016/S1470-2045(21)00075-9
- Yang Z, Cai Z, Cai Q, et al. . Sequential induction chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: the three-year report of a phase II, single center, randomized, non-inferiority trial. Cancer Med. 2021;10(12):3886-3895. doi:10.1002/cam4.3936
- Liao W, Huang J, Wu Q, et al. . Concurrent chemoradiotherapy with nedaplatin versus cisplatin in stage II-IVB nasopharyngeal carcinoma: a cost-effectiveness analysis. Oral Oncol. 2019;93:15-20. doi:10.1016/j.oraloncology.2019.04.003
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