Triple-double.

Top Line: In 2019, a randomized trial showed a ~5% improvement in overall survival with induction gemcitabine and cisplatin for locally advanced nasopharyngeal cancer (NPC).

The Study: Induction chemotherapy is now a preferred approach in this population. But what is the ideal induction chemo regimen? A meta-analysis of induction studies found that the inclusion of a taxane may result in better treatment outcomes. In this phase 3 trial, 238 patients with stage IVA-IVB NPC received 2 cycles of induction chemo followed by definitive, cisplatin-based chemoradiation. They were randomized to receive either cisplatin and fluorouracil (PF) versus paclitaxel, cisplatin, and capecitabine (TPC). Note here the modification to the classic TPF regimen with exchange of paclitaxel for docetaxel and capecitabine for fluorouracil. Also note the decrease from 3 cycles to 2. Induction TPC significantly improved 3-year failure-free survival compared to PF (83.5% v 68.9%). This was a result of a decrease in the risk of both distant metastasis (HR 0.49) and locoregional recurrence (HR 0.40). Though response to induction chemo was similar, those in the TPC arm had a higher rate of complete response after completing all treatment (94% v 86%). The benefits of TPC did not translate into improved OS, though. Nevertheless, there was no additional increase in grade 3 or 4 toxicity with TPC (grade 3: 58% v 66%; grade 4: 14% v 18%.

TBL: Induction TPC results in superior treatment outcomes with no increased toxicity compared to induction PF in patients with locoregionally advanced nasopharyngeal carcinoma. | Li, JAMA Oncol 2022