Sequential Chemoradiotherapy Plus Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma
According to results from a phase 3 trial, sequential chemoradiotherapy plus concurrent chemoradiotherapy demonstrated noninferiority compared to induction chemoradiotherapy plus concurrent chemoradiotherapy among newly diagnosed patients with locoregionally advanced nasopharyngeal carcinoma.
“Induction chemotherapy plus concurrent chemoradiotherapy has been a standard treatment for locoregionally advanced nasopharyngeal carcinoma but with high acute toxic effects in [the concurrent chemoradiotherapy] phase,” stated Fen Xue, MD, Fudan University Shanghai Cancer Center, Shanghai, China, and coauthors. “Whether [concurrent chemoradiotherapy] can be safely replaced by radiation therapy with adjuvant chemotherapy is unknown.”
In this open-label study, 420 patients with newly diagnosed stage III/IVA locoregionally advanced nasopharyngeal carcinoma were randomized on a 1-to-1 basis to undergo 2 cycles of induction chemoradiotherapy (1000 mg/m2 of gemcitabine plus 25 mg/m2 of cisplatin once every 3 weeks) followed by either radiotherapy alone and 2 cycles of adjuvant chemotherapy with gemcitabine and cisplatin (n = 210) or radiotherapy and concurrent cisplatin weekly (n = 210). Primary end points included failure-free survival (FFS) and acute nonhematological safety.
At analysis, 3-year FFS rate was 83.7% in the sequential chemoradiotherapy arm and 79.5% in the induction chemoradiotherapy plus concurrent chemoradiotherapy arm (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.50 to 1.19; P = .24). The most frequently observed grade ≥3 acute nonhematological toxicities included acute mucositis (29% and 41.9%, respectively; P < .001), nausea (9.5% and 18.1%, respectively; P = .01), and vomiting (3.8% and 9.5%, respectively; P = .02).
“Results from this noninferiority randomized clinical trial suggest that [sequential chemoradiotherapy] is noninferior to [induction chemoradiotherapy plus concurrent chemoradiotherapy] in terms of 3-year FFS in [locally advanced nasopharyngeal carcinoma], with less severe acute nonhematological toxic effects,” concluded Dr Xue et al.
Source:
Xue F, Ou D, Xie C, et al. Sequential vs induction plus concurrent chemoradiotherapy in nasopharyngeal carcinoma. JAMA Oncol. Published online : July 24, 2025. doi: 10.1001/jamaoncol.2025.2191
