Where have you gemcitabine?
Headline: Induction chemo for nasopharyngeal carcinoma is making a comeback. In this Chinese phase 3 trial, patients with stage III-IVB non-keratinizing nasopharyngeal carcinoma were randomized to receive either neoadjuvant chemotherapy or proceed directly to definitive chemoradiation. The induction regimen in this trial consisted of gemcitabine and cisplatin every 3 weeks for 3 cycles, and the concurrent cisplatin was 100 mg/m2 every three weeks. The response rate in the induction arm was 95%, and the vast majority of patients made it through induction therapy and into radiation. Induction chemo resulted in a nearly 10% improvement in recurrence-free survival at 3 years (77→ 85%). In addition, there was a nearly 5% improvement in 3 year overall survival from 90 → 95%. Both outcomes were potentially driven by improvements in distant recurrence rates with induction chemo at the cost of an increase in grade 3+ toxicity from 55 → 75%. TBL: Induction gem/cis improves recurrence-free and overall survival in Chinese patients with advanced, non-keratinizing nasopharyngeal carcinoma. | Zhang, N Engl J Med 2019
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