-
Trends Journal of Sciences Research 2018, 3(2), 60-68. http://doi.org/10.31586/Cancer.0302.01Received: August 1, 2018 Revised: September 1, 2018 Accepted: September 5, 2018 Published: September 7, 2018AbstractFiguresObjective: To evaluate the efficacy and safety of nimotuzumab in combination with radiochemotherapy as the primary treatment in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Methods: We retrospectively reviewed patients with locoregionally advanced nasopharyngeal carcinoma from September 2012 to December 2016. 188 newly diagnosed patients with stage III?IVB nasopharyngeal carcinoma[...] Read more.Objective: To evaluate the efficacy and safety of nimotuzumab in combination with radiochemotherapy as the primary treatment in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Methods: We retrospectively reviewed patients with locoregionally advanced nasopharyngeal carcinoma from September 2012 to December 2016. 188 newly diagnosed patients with stage III?IVB nasopharyngeal carcinoma were treated with at least 1-2 cycles of chemotherapy concurrently with planned IMRT. 88 patients received nimotuzumab 200 mg/week. Acute and late radiation-related toxicities were graded according to the Acute and Late Radiation Morbidity Scoring Criteria of Radiation Therapy Oncology Group. Results: After 3 months of treatment, the complete response rates of nasopharyngeal tumors in the study group and the control group were 78.4% and 65.5%, respectively (?2=4.070, P=0.044). The total complete response rates of cervical lymph nodes in the study group and the control group were 80.7% and 67.6% respectively (?2=4.022, P=0.045).The median cycle for nimotuzumab addition was 6.3 weeks. With a median follow-up of 36.3 months (range, 12?72 months), the estimated 3-year progression failure-free survival and overall survival rates for the study group and the control group were 85.24% vs 81.97% and 96.67% vs 90.0%, respectively. The 3-year local recurrence-free survival rates for the study group and the control group were 96.67% vs 83.60%, respectively (P=0.047). Grade 3 radiation-induced mucositis accounted for 36.4% of treated patients. No skin rash and infusion reaction were observed, distinctly from what is reported in control patients. Conclusion: Nimotuzumab plus chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma showed promising outcomes in terms of locoregional control, without increasing the incidence of radiation-related toxicities for patients. Full articleReferences
Figure 1 of 1
[1]Tang LL, Chen WQ, Xue WQ, He YQ, Zheng RS, ZengYX, Jia WH. Global trends in incidence and mortality of nasopharyngeal carcinoma. Cancer Lett. 2016; 374:22?30.[2]Lee N, Xia P, Quivey JM, et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys. 2002;53:12?22.[3]Chen L, Mao YP, Xie FY, Liu LZ, Sun Y, Tian L, TangLL, Lin AH, Li L, Ma J. The seventh edition of UICC/AJCC staging system for nasopharyngeal carcinoma is prognostically useful for patients treated with intensity modulated radiotherapy from an endemic area in China. Radiother Oncol. 2012;104:331-337.[4]Lee AW, Tung SY, Chua DT, Ngan RK, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GK, Law SC, O?Sullivan B, Yau TK, et al. Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst. 2010; 102:1188?98.[5]Fountzilas G, Ciuleanu E, Bobos M, Kalogera-Fountzila A, Eleftheraki AG, Karayannopoulou G, et al. Induction chemotherapy followed by concomitant radiotherapy and weekly cisplatin versus the same concomitant chemoradiotherapy in patients with nasopharyngeal carcinoma: a randomized phase II study conducted by the Hellenic Cooperative Oncology Group (HeCOG) with biomarker evaluation. Ann Oncol. 2012; 23:427?35.[6]Huang PY, Cao KJ, Guo X, Mo HY, Guo L, Xiang YQ, et al. A randomized trial of induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus radiotherapy for locoregionally advanced nasopharyngeal carcinoma. Oral Oncol. 2012; 48:1038?44.[7]Baujat B, Audry H, Bourhis J, Chan AT, Onat H, ChuaDT, Kwong DL, Al-Sarraf M, Chi KH, HareyamaM,Leung SF, Thephamongkhol K, Pignon JP, and MAC-NPC Collaborative Group. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta analysisof eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys. 2006; 64:47?56.[8]Zhang MX, Li J, Shen GP, Zou X, Xu JJ, Jiang R, et al. Intensity-modulated radiotherapy prolongs the survival of patients with nasopharyngeal carcinoma compared with conventional two-dimensional radiotherapy: A10-year experience with a large cohort and long follow-up. Eur J Cancer. 2015;51: 2587-95.[9]Lee AW, Sze WM, Au JS, Leung SF, Leung TW, Chua DT, et al. Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kongexperience. Int J Radiat Oncol Biol Phys. 2005; 61: 1107-16.[10]Wu F, Wang R, Lu H, Wei B, Feng G, Li G, et al. Concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: treatment outcomes of a prospective, multi centric clinical study. Radiother Oncol. 2014; 112:106?11.[11]Vallath S, Hynds RE, Succony L, Janes SM, Giangreco A. Targeting EGFR signalling in chronic lung disease: therapeutic challenges and opportunities. Eur Respir J. 2014,44:513?522.[12]Reddy BK, Lokesh V, Vidyasagar MS, Shenoy K, Babu KG, Shenoy A, et al. Nimotuzumab provides survival benefit to patients with inoperable advanced squamous cell carcinoma of the head and neck: a randomized, open-label, phase IIb, 5-year study in Indian patients. Oral Oncol. 2014; 50:498?505.[13]Wang SS, Guan ZZ, Xiang YQ, Wang B, Lin TY, Jiang WQ, et al. Significance of EGFR and p-ERK expression in nasopharyngeal carcinoma. Chin J Oncol?2006,28?1??28-31.[14]Chua DT, Nicholls JM, Sham JS, Au GK. Prognostic value of epidermal growth factor receptor expression in patients with advanced stage nasopharyngeal carcinoma treated with induction chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys. 2004;59(1):11?20.[15]Modjtahedi H, Essapen S. Epidermal growth factor receptor inhibitors incancer treatment: advances, challenges and opportunities. Anti-Cancer Drugs. 2009;20(10):851?5.[16]Crombet T, Osorio M, Cruz T, Roca C, del Castillo R, Mon R, et al. Use of the humanized anti-epidermal growth factor receptor monoclonal antibody h-R3 in combination with radiotherapy in the treatment of locally advanced head and neck cancer patients. J Clin Oncol. 2004; 22:1646-54.[17]Lo HW, Hsu SC, Ali-Seyed M, Gunduz M, Xia W, Wei Y, et al. Nuclear interaction of EGFR and STAT3 in the activation of the iNOS/NO pathway. Cancer Cell 2005,7:575?589.[18]Cuneo KC, Nyati MK, Ray D, Lawrence TS. EGFR targeted therapies andradiation: optimizing efficacy by appropriate drug scheduling and patients election. Pharmacol Ther. 2015;154:67-77.[19]Talavera A, Friemann R, Gomez-Puerta S, Martinez-Fleites C, GarridoG,Rabasa A, Lopez-Requena A, Pupo A, Johansen RF, Sanchez O, et al. Nimotuzumab, an antitumor antibody that targets the epidermal growth factor receptor, blocks ligand binding while permitting the active receptor conformation. Cancer Res. 2009;69(14):5851?9.[20]Huang XD, Yi JL, Gao L, Xu GZ, Jin J, Yang WZ, Lu TX, Wu SX, Wu RH, Hu WH, Xie WC, Han F, Gao YH, Gao JM, Pan JJ, Chen CB, Lang JY, Li T, Dong Y, Fu, YB, Fan L, Li BS, Li J, Wang XH, Chen BX, Gao XS, Zhang P, Wu XW, Hu BQ. Multi-center phase 2 clinical trial of humanized anti-epidernal fator receptor monoclonal antibody h-R3 combined with radiotherapy for locoregionally advanced nasopharyngeal carcinoma . Chin J Oncol?2007, 29?3??197-200.[21]HM Li, P Li, YJ Qian, et al. A retrospective paired study: efficacy andtoxicity of nimotuzumab versus cisplatinconcurrent with radiotherapy innasopharyngeal carcinoma. BMC Cancer (2016) 16:946.[22]F Wang, C Jiang, Z Ye, Q Sun, T Liu, M Xu, et al. Efficacy and safety of nimotuzumab with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma. Oncotarget, 2017, 8: 75544-75556.[23]R You, YJ Hua, YP Liu, et al. Concurrent Chemoradiotherapy with or without Anti-EGFR-Targeted Treatment for Stage II-IVb Nasopharyngeal Carcinoma: Retrospective Analysis with a Large Cohort and Long Follow-up. Theranostics 2017, 7:2314-2324.[24]R Zhai, H Ying, F Kong, et al. Experience with combination of nimotuzumab and intensity-modulated radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. Onco Targets and Therapy 2015:8 3383?3390.[25]F Wang, C Jiang, Z Ye, T Liu, F Yan, L Wang, et al. Long-Term Use of Nimotuzumab in Combination with Intensity-Modulated Radiotherapy and Chemotherapy in the Treatment of Locoregionally Advanced Nasopharyngeal Carcinoma: Experience of a Single Institution. Onco Res, 2017, 26:277-287.[26]Z Li, Y Li,S Yan, J Fu, Q Zhou, X Huang, et al. Nimotuzumab combined with concurrent chemoradiotherapy benefits patients with advanced nasopharyngeal carcinoma. OncoTargets and Therapy 2017:10 5445?5458.[27]WMA, World Medical Association. Declaration of Helsinki. J Am Med Assoc. 2013;227:925?26.