Metronomic S1 Adjuvant Chemotherapy Improves Survival in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose This study aimed to investigate the efficacy and safety of using metronomic S-1 adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma (LANPC). Materials and Methods We retrospectively collected data on patients diagnosed with LANPC between January 2016 and December 2021. All patients were treated with induction chemotherapy and concurrent chemoradiotherapy with or without metronomic chemotherapy (MC). Toxicities during MC were recorded. The chi-square test, Kaplan-Meier methods, propensity score matching (PSM), and Cox proportional hazards model were used for statistical analyses. Results A total of 474 patients were identified, including 64 (13.5%) and 410 (83.5%) patients with or without receiving MC, respectively. Patients who received metronomic S-1 had significantly better 3-year locoregional recurrence-free survival (LRFS) (100% vs. 90.9%, p=0.038), distant metastasis-free survival (DMFS) (98.5% vs. 84.1%, p=0.002), disease-free survival (DFS) (98.4% vs. 77.5%, p < 0.001), and overall survival (OS) (98.0% vs. 87.7%, p=0.008) compared to those without metronomic S-1. The multivariate prognostic analysis revealed that metronomic S-1 was identified as an independent prognostic factor associated with better DMFS (hazard ratio [HR], 0.074; p=0.010), DFS (HR, 0.103; p=0.002) and OS (HR, 0.127; p=0.042), but not in LRFS (p=0.071). Similar results were found using PSM. Common adverse events observed in the metronomic S-1 group included leukopenia, neutropenia, increased total bilirubin, anorexia, rash/desquamation, and hyperpigmentation. All patients with adverse events were grade 1-2. Conclusion It is worth conducting a randomized controlled trial to assess the effect of metronomic S-1 on survival outcomes and toxicities of LANPC.
Abstract
Purpose This study aimed to investigate the efficacy and safety of using metronomic S-1 adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma (LANPC). Materials and Methods We retrospectively collected data on patients diagnosed with LANPC between January 2016 and December 2021. All patients were treated with induction chemotherapy and concurrent chemoradiotherapy with or without metronomic chemotherapy (MC). Toxicities during MC were recorded. The chi-square test, Kaplan-Meier methods, propensity score matching (PSM), and Cox proportional hazards model were used for statistical analyses. Results A total of 474 patients were identified, including 64 (13.5%) and 410 (83.5%) patients with or without receiving MC, respectively. Patients who received metronomic S-1 had significantly better 3-year locoregional recurrence-free survival (LRFS) (100% vs. 90.9%, p=0.038), distant metastasis-free survival (DMFS) (98.5% vs. 84.1%, p=0.002), disease-free survival (DFS) (98.4% vs. 77.5%, p < 0.001), and overall survival (OS) (98.0% vs. 87.7%, p=0.008) compared to those without metronomic S-1. The multivariate prognostic analysis revealed that metronomic S-1 was identified as an independent prognostic factor associated with better DMFS (hazard ratio [HR], 0.074; p=0.010), DFS (HR, 0.103; p=0.002) and OS (HR, 0.127; p=0.042), but not in LRFS (p=0.071). Similar results were found using PSM. Common adverse events observed in the metronomic S-1 group included leukopenia, neutropenia, increased total bilirubin, anorexia, rash/desquamation, and hyperpigmentation. All patients with adverse events were grade 1-2. Conclusion It is worth conducting a randomized controlled trial to assess the effect of metronomic S-1 on survival outcomes and toxicities of LANPC.
참고문헌 (32)
- Chen YP, "Nasopharyngeal carcinoma", Lancet, 394, pp.64~80 (2019)
- Wu CF, "Development and validation of a web-based calculator to predict individualized conditional risk of site-specific recurrence in nasopharyngeal carcinoma : analysis of 10, 058 endemic cases", Cancer Commun(Lond), 41, pp.37~50 (2021)
- Pan JJ, "Proposal for the 8th edition of the AJCC", UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy, 2016, pp.122, 546~558
- Chen YP, "Chemotherapy in combination with radiotherapy for definitive-intent treatment of stage II-IVA nasopharyngeal carcinoma : CSCO and ASCO guideline", J Clin Oncol, 39, pp.840~859 (2021)
- Tang LL, "The Chinese Society of Clinical Oncology(CSCO)clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma", Cancer Commun(Lond), 41, pp.1195~1227 (2021)
- Chen YP, "Induction chemotherapy plus concurrent chemoradiotherapy in endemic nasopharyngeal carcinoma : individual patient data pooled analysis of four randomized trials", Clin Cancer Res, 24, pp.1824~1833 (2018)
- Zhang Y, "Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma", N Engl J Med, 381, pp.1124~1135 (2019)
- Lv J, "Liquid biopsy tracking during sequential chemo-radiotherapy identifies distinct prognostic phenotypes in nasopharyngeal carcinoma", Nat Commun, 10, pp.3941~ (2019)
- Ko JM, "Clinical utility of serial analysis of circulating tumour cells for detection of minimal residual disease of metastatic nasopharyngeal carcinoma", Br J Cancer, 123, pp.114~125 (2020)
- Chen L, "Adjuvant chemotherapy in patients with locoregionally adv-anced nasopharyngeal carcinoma : long-term results of a phase 3 multicentre randomised controlled trial", Eur J Cancer, 75, pp.150~158 (2017)
- Chan AT, "Analysis of plasma Epstein-Barr virus DNA in nasopharyngeal cancer after chemoradiation to identify high-risk patients for adjuvant chemotherapy : a randomized controlled trial", J Clin Oncol, 36, pp.3091~3100 (2018)
- Wang X, "Effect of capecitabine maintenance therapy using lower dosage and higher frequency vs observation on disease-free survival among patients with early-stage triple-negative breast cancer who had received standard treatment : the SYSUCC-001 randomized clinical trial", JAMA, 325, pp.50~58 (2021)
- Woo IS, "Metronomic chemotherapy in metastatic colorectal cancer", Cancer Lett, 400, pp.319~324 (2017)
- Xu K, "The efficacy and toxicity of metronomic oral vinorelbine monotherapy in patients with non-small cell lung cancer : a meta-analysis", Int J Clin Oncol, 25, pp.1624~1634 (2020)
- Chen YP, "Metronomic capecitabine as adjuvant therapy in locoregionally advanced nasopharyngeal carcinoma : a multicentre, open-label, parallel-group, randomised, controlled, phase 3 trial", Lancet, 398, pp.303~313 (2021)
- Lu Y, "Maintenance therapy improves the survival outcomes of patients with metastatic nasopharyngeal carcinoma responding to first-line chemotherapy : a multicentre, randomized controlled clinical study", J Cancer Res Clin Oncol, 149, pp.4327~4338 (2023)
- Zong J, "Maintenance chemotherapy using S-1 following definitive chemoradiotherapy in patients with N3 nasopharyngeal carcinoma", Radiat Oncol, 14, pp.182~ (2019)
- Zhang S, "A retrospective study of concurrent chemoradiotherapy plus S-1 adjuvant chemotherapy on curative effect for treatment of patients with N3 stage nasopharyngeal carcinoma", Cancer Manag Res, 10, pp.1705~1711 (2018)
- Tao HY, "Efficacy of adjuvant chemotherapy", maintenance chemotherapy after induction chemotherapy and concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma : experiences of two centers, 2023, pp.12, 6811~6824
- Zong J, "Administration of oral maintenance chemotherapy for 1 year following definitive chemoradiotherapy may improve the survival of patients with stage N3 nasopharyngeal carcinoma", Oral Oncol, 118, pp.105313~ (2021)
- Choi S, "Long-term survival outcomes of elderly patients treated with S-1 or capecitabine plus oxaliplatin for stage II or III gastric cancer : a multicenter cohort study", J Gastric Cancer, 22, pp.67~77 (2022)
- Li J, "Docetaxel", S-1 versus docetaxel, Medicine(Baltimore), pp.2015, 94[DOI]
- He AB, "Efficacy of S-1 vs capecitabine for the treatment of gastric cancer : a meta-analysis", World J Gastroenterol, 21, pp.4358~4364 (2015)
- Zheng H, "Prognostic effect of residual plasma Epstein-Barr viral DNA after induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma", Cancer Med, 12, pp.14979~14987 (2023)
- Huang CL, "Oral chemotherapy versus observation alone in nasopharyngeal carcinoma patients with persistently detected circulating cell-free Epstein-Barr virus DNA during follow-up", Radiother Oncol, 190, pp.110032~ (2024)
- Twu CW, "Metronomic adjuvant chemotherapy improves treatment outcome in nasopharyngeal carcinoma patients with postradiation persistently detectable plasma Epstein-Barr virus deoxyribonucleic acid", Int J Radiat Oncol Biol Phys, 89, pp.21~29 (2014)
- She L, "Cost-effectiveness analysis of metronomic capecitabine as adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma", Front Oncol, 12, pp.904372~ (2022)
- Caudell JJ, "NCCN Guidelines(R)insights : head and neck cancers, version 1. 2022", J Natl Compr Canc Netw, 20, pp.224~234 (2022)
- Tsukahara K, "Randomized phase III trial of adjuvant chemotherapy with S-1 after curative treatment in patients with squamous-cell carcinoma of the head and neck(ACTS-HNC)", PLoS One, 10, pp.e0116965~ (2015)
- Kitani Y, "Impact of combined modality treatment with radiotherapy and S-1 on T2N0 laryngeal cancer : possible improvement in survival through the prevention of second primary cancer and distant metastasis", Oral Oncol, 71, pp.54~59 (2017)
- Furusaka T, "Consecutive daily low-dose S-1 adjuvant chemotherapy after radical treatment for squamous cell carcinoma in head and neck cancer", Acta Otolaryngol, 131, pp.1099~1103 (2011)
- Andre N, "Metronomic chemotherapy : direct targeting of cancer cells after all?", Trends Cancer, 3, pp.319~325 (2017)