United States, ( May 30, 2018) - Nasopharyngeal carcinoma (NPC) is a unique head and neck cancer with an extremely unbalanced endemic distribution, which is common in southern part of China. Combined radiotherapy and chemotherapy is the primary treatment modality for locoregionally-advanced NPC. However, the optimal chemoradiotherapy strategy for NPC remains controversial.

Dr. Jun Ma and colleagues of Sun Yat-sen University Cancer Center in Guangzhou has been constantly working towards ways to improve the survival and quality of life of NPC patients. In 2012, concurrent chemoradiotherapy followed by adjuvant chemotherapy is the highest recommended evidence (Level 1), while induction chemotherapy plus concurrent chemoradiotherapy is in low level (Level 3). However, the efficacy of adjuvant chemotherapy remains uncertain. Dr. Ma and colleagues conducted a clinical trial and observed no significant benefit for additional adjuvant chemotherapy. Further, using data of this trial, Dr. Chen, Dr. Ma and colleagues performed a pooled-analysis study combining other relevant trials and further confirmed that additional adjuvant chemotherapy could not improve survial but increase toxic effects, which may waste medical resources (reported in Ann Oncol, 2015).

"In this era of intensity modulated radiation therapy, distant metastasis is the primary treatment failure and the conventional adjuvant chemotherapy may not be suitable for NPC patients," Dr. Jun Ma said. “Induction chemotherapy offers the advantages of better tolerability and early eradication of micrometastases, it may be a promising strategy now.”

To assess the precise role of additional induction chemotherapy to concurrent chemoradiotherapy in NPC, Dr. Chen, Dr. Ma and colleagues from endemic areas perform a rigorous individual patient data pooled analysis of four high-quality trials collaboratively. As expected, additional induction chemotherapy to concurrent chemoradiotherapy could reduce distant metastasis and improve survival for NPC patients, Dr. Chen, Dr. Ma and colleagues reported in Clin Cancer Res, online Feb 5. In the newest guideline, induction chemotherapy plus concurrent chemoradiotherapy has been upgraded from level 3 to 2A, while concurrent chemoradiotherapy followed by adjuvant chemotherapy was downgraded from level 1 to 2A.

Considering uneven geographical distribution and small number of randomized trials available, these relevant trials and the two pooled-analysis studies by physicians mainly from China greatly push the advances of individualized treatment for NPC, and represent milestones in the optimization of chemoradiotherapy strategy for NPC in the era of precision medicine.

To know more information, visit http://clincancerres.aacrjournals.org/content/24/8/1824.long

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