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Weekly versus triweekly concurrent chemoradiation for nasopharyngeal cancer
abstracts
Annals of Oncology
Honoraria (self): Bristol Myers Squibb; Honoraria (self): Merck ; Honoraria (self): Roche; Honoraria (self): Alphas Pharmaceutical. D.R. Chirovsky: Shareholder / Stockholder / Stock options, Full / Parttime employment: Merck and Co. Inc. H. Kuyas: Research grant / Funding (institution), Full / Parttime employment: Kantar Health Division. V. Auclair: Research grant / Funding (institution), Full / Part-time employment: Kantar Health Division. S. Abounit: Research grant / Funding (institution), Full / Part-time employment: Kantar Health Division. S. Joo: Shareholder / Stockholder / Stock options, Full / Part-time employment: Merck and Co, Inc. R. Shah: Full / Part-time employment: Merck and Co, Inc. All other authors have declared no conflicts of interest.
298P
Long-term complication and outcomes after induction chemotherapy with TPF followed by chemoradiotherapy for nasopharyngeal cancer
S-H. Cho, I.J. Chung, W.K. Bae, J. Hwang Hemato-Oncology, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea Background: Although the acute toxicities during induction TPF in head and neck cancers are well known, there has been little studied about the long term complications including of outcomes in nasopharyngeal cancer (NPC). The purpose of this study is to evaluate the long term complications and survival outcomes in patients with locally advanced NPC treated with induction TPF followed by CRT. Methods: From 2004 to 2016, 244 patients were diagnosed as NPC. Among them, 104 patients who completed the 3 cycles of TPF (docetaxel 75 mg/m2 and cisplatin 75/m2 day 1, plus fluorouracil 1000 mg/m2 days 1–4, every 3 wks) followed by CRT were evaluated. During CRT, cisplatin was given as either a weekly or 3 weeks regimen and RT was performed at 65–70 Gy. After completing TPF and CRT, follow up imaging and regular examination was checked by ENT specialist. Results: The median follow-up duration was 60 months (range, 13-135). 5Y OS rate and 3Y PFS rate were 88.963.7% (95%CI 81.65-96.15) and 80.464.5 (95%CI 71.5889.22). PFS was significantly associated with TNM (p ¼ 0.001), especially N stage (N3, 3Y-PFS 42.9%, p ¼ 0.001). The response after induction chemotherapy and postop CRT were significantly associated with PFS and OS. ENT complications such as hearing impairment, chronic infection, ear drum perforation were shown in 31 patients (30%) and renal impairment (Clcr60) was developed in 30 patients (30%). The incidence of both complications was significantly associated with age (>65 years, ENT Cx, p ¼ 0.011, renal Cx, 0.032). However, age was not attenuate response rate or survival. The decreased Clcr before starting RT was associated with long term renal complication, and cumulative cisplatin dose did not affect treatment outcome. In addition, both ENT and renal toxicities were not associated with the radiation dose or cumulative cisplatin dose. Conclusions: TPF followed by CCRT is an effective treatment scheme for advanced NPC. However, long term complications in ENT and decreased renal function were considerable, especially in elderly. Therefore, careful observation and management are required for high risk patients and optimal cisplatin adjustment could be prevent renal complication without affecting the treatment outcomes. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 9 | November 2019
299P
Weekly versus triweekly concurrent chemoradiation for nasopharyngeal cancer
S. Sudibio, H. Handoko, M. Auzan, G.B. Prajogi Radiotherapy Department, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia Background: Nasopharyngeal cancer is the most common head and neck cancer in Indonesia with prevalence of 28.4% among all adult head and neck cancer. Radiotherapy and chemotherapy are the main modalities for nasopharyngeal cancer treatment, With proper treatment, patients with nasopharyngeal cancer would have 5year survival rate of above 80%, even in locally advanced nasopharyngeal cancer. However toxicity associated with nasopharyngeal cancer treatment is quite burdensome for the patients especially toxicity in terms of hematology, mucositis, nausea, and vomiting. Due to the burdening toxicity of chemoradiation treatment for the patients, several chemotherapy schedules were attempted. We aimed to search and elucidate high quality evidence available to date to answer our clinical question, whether triweekly or weekly concurrent chemoradiation is better for nasopharyngeal cancer treatment in terms of survival. Methods: Literature searching was conducted on 3 databases: PubMed, EBSCOhost, and Scopus using keyword “Nasopharyngeal Cancer”, “Weekly Chemotherapy”, “Triweekly Chemotherapy”, “Overall Survival” and its synonyms using both MeSH and non-MeSH terms. Critical Appraisal for selected studies was done by 3 different person, using CEBM Critical Appraisals Tools. Results: Six studies were selected to be relevant after elaborate search, which was then critically apprasied and found to be valid. Results from all those 6 studies found that weekly vs. triweekly chemoradiation regimen leads to similar survival outcome in nasopharyngeal cancer patients. Overall Survival (OS) rates from those 6 studies showed comparable result among both regimens (3-Year OS, 91% vs 90.8%; 5-year OS, 89% vs. 91%, 85.6% vs 90%, 78.9% vs 85.2%) and, all OS rate outcomes didn’t reach significant difference for all 6 studies. Conclusions: Weekly and triweekly chemoradiation regimens for nasopharyngeal cancer were shown to be similar in terms of overall survival. The choice of weekly or triweekly chemoradiation for nasopharyngeal cancer patient should tailored according to institutional condition and capability. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
300P
Endoscopic nasopharyngectomy for localized stage I nasopharyngeal carcinoma
M-Y. Chen, L. You-Ping, X. Zou, X. Lv, Y-J. Hua, M-H. Hong Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China Background: The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy (IMRT) as primary curative treatment for newly diagnosed nasopharyngeal carcinoma (NPC), but the radiation-related complications and relatively high medical costs cannot be ignored. We examined whether endoscopic nasopharyngectomy (ENPG) could be an effective alternative treatment for localized stage I NPC. Methods: Ten newly diagnosed localized stage I NPC patients received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center. The survival outcomes, quality of life (QOL), and medical costs were collected. Simultaneously, data for 329 stage I NPC patients treated with IMRT were collected as a reference. Results: After a median follow-up of 59.0 months (95%CI 53.4-64.6), no death, locoregional recurrence, or distant metastasis was observed in the 10 ENPG-treated patients. The 5-year overall survival, local relapse-free survival, regional relapse-free survival and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients (100% vs. 99.1%, 100% vs. 97.7%, 100% vs. 99.0%, 100% vs. 97.4%, respectively, P > 0.05). In addition, compared with IMRT, ENPG was associated with decreased total medical costs ($4090.4261502.65 vs. 12620.8864242.65, P < 0.001) and improved QOL scores including dry mouth (3.3 6 10.5 vs. 34.4 6 25.8, P < 0.001) and sticky saliva (3.3 6 10.5 vs. 32.6 6 23.3, P < 0.001). Conclusions: ENPG alone was associated with promising long-term survival outcomes, low medical costs, and excellent QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients. Legal entity responsible for the study: Mingyuan Chen. Funding: National Natural Science Foundation of China. Disclosure: All authors have declared no conflicts of interest.
doi:10.1093/annonc/mdz428 | ix101
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_9/mdz428.013/5638501 by EKU Libraries user on 04 December 2019
Methods: A retrospective chart review was conducted in South Korea (SK) and Taiwan (TW) to identify patients who initiated first-line systemic therapy for R/M NPC between January 1, 2012 and June 30, 2013. Patients were followed through December 31, 2015. Stratification of study outcomes was performed per location of metastases for patients with distant metastatic disease vs. metastatic disease in distant lymph nodes only. Results: Among 154 R/M NPC patients enrolled across 12 sites, median age was 52 years (interquartile range 45-59), 78% were male, and 87% had ECOG 0-1. In TW (N ¼ 104), all patients had distant metastatic disease either as newly diagnosed metastatic (stage IVc) disease (32%) or disease recurrence with distant metastases (68%). In SK (N ¼ 50), 42% of patients had distant metastatic disease, and 58% presented with distant lymph nodes only. Among patients with distant metastatic disease, patients mainly received systemic therapy only as first-line treatment in both TW (72%) and SK (67%), among which platinum þ 5-FU was most common (34%). Remaining patients with distant metastatic disease received systemic therapy þ radiation (28% TW; 33% SK). In contrast, patients with distant lymph nodes only in SK primarily received systemic therapy þ radiation (83%). Median OS for patients with distant metastatic disease who received systemic therapy only was 23 months (95% confidence interval [CI] 18-32), compared with 32 months (95% CI: 22-Not Determined) for patients who received systemic therapy þ radiation. Median OS was not reached for patients with distant lymph nodes only who received systemic therapy þ radiation. Conclusions: Differences in the location of metastases for patients with R/M NPC led to variation in treatment approaches across TW and SK. Prognosis in patients with distant metastatic disease remains poor with limited therapeutic options, underscoring the need for newer, more efficacious treatments. Legal entity responsible for the study: Merck and Co., Inc. Funding: Merck and Co., Inc. Disclosure: M-J. Ahn: Honoraria (self): Merck Sharpe and Dohme; Honoraria (self): Astra-Zeneca;
Annals of Oncology
Honoraria (self): Bristol Myers Squibb; Honoraria (self): Merck ; Honoraria (self): Roche; Honoraria (self): Alphas Pharmaceutical. D.R. Chirovsky: Shareholder / Stockholder / Stock options, Full / Parttime employment: Merck and Co. Inc. H. Kuyas: Research grant / Funding (institution), Full / Parttime employment: Kantar Health Division. V. Auclair: Research grant / Funding (institution), Full / Part-time employment: Kantar Health Division. S. Abounit: Research grant / Funding (institution), Full / Part-time employment: Kantar Health Division. S. Joo: Shareholder / Stockholder / Stock options, Full / Part-time employment: Merck and Co, Inc. R. Shah: Full / Part-time employment: Merck and Co, Inc. All other authors have declared no conflicts of interest.
298P
Long-term complication and outcomes after induction chemotherapy with TPF followed by chemoradiotherapy for nasopharyngeal cancer
S-H. Cho, I.J. Chung, W.K. Bae, J. Hwang Hemato-Oncology, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea Background: Although the acute toxicities during induction TPF in head and neck cancers are well known, there has been little studied about the long term complications including of outcomes in nasopharyngeal cancer (NPC). The purpose of this study is to evaluate the long term complications and survival outcomes in patients with locally advanced NPC treated with induction TPF followed by CRT. Methods: From 2004 to 2016, 244 patients were diagnosed as NPC. Among them, 104 patients who completed the 3 cycles of TPF (docetaxel 75 mg/m2 and cisplatin 75/m2 day 1, plus fluorouracil 1000 mg/m2 days 1–4, every 3 wks) followed by CRT were evaluated. During CRT, cisplatin was given as either a weekly or 3 weeks regimen and RT was performed at 65–70 Gy. After completing TPF and CRT, follow up imaging and regular examination was checked by ENT specialist. Results: The median follow-up duration was 60 months (range, 13-135). 5Y OS rate and 3Y PFS rate were 88.963.7% (95%CI 81.65-96.15) and 80.464.5 (95%CI 71.5889.22). PFS was significantly associated with TNM (p ¼ 0.001), especially N stage (N3, 3Y-PFS 42.9%, p ¼ 0.001). The response after induction chemotherapy and postop CRT were significantly associated with PFS and OS. ENT complications such as hearing impairment, chronic infection, ear drum perforation were shown in 31 patients (30%) and renal impairment (Clcr60) was developed in 30 patients (30%). The incidence of both complications was significantly associated with age (>65 years, ENT Cx, p ¼ 0.011, renal Cx, 0.032). However, age was not attenuate response rate or survival. The decreased Clcr before starting RT was associated with long term renal complication, and cumulative cisplatin dose did not affect treatment outcome. In addition, both ENT and renal toxicities were not associated with the radiation dose or cumulative cisplatin dose. Conclusions: TPF followed by CCRT is an effective treatment scheme for advanced NPC. However, long term complications in ENT and decreased renal function were considerable, especially in elderly. Therefore, careful observation and management are required for high risk patients and optimal cisplatin adjustment could be prevent renal complication without affecting the treatment outcomes. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 9 | November 2019
299P
Weekly versus triweekly concurrent chemoradiation for nasopharyngeal cancer
S. Sudibio, H. Handoko, M. Auzan, G.B. Prajogi Radiotherapy Department, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia Background: Nasopharyngeal cancer is the most common head and neck cancer in Indonesia with prevalence of 28.4% among all adult head and neck cancer. Radiotherapy and chemotherapy are the main modalities for nasopharyngeal cancer treatment, With proper treatment, patients with nasopharyngeal cancer would have 5year survival rate of above 80%, even in locally advanced nasopharyngeal cancer. However toxicity associated with nasopharyngeal cancer treatment is quite burdensome for the patients especially toxicity in terms of hematology, mucositis, nausea, and vomiting. Due to the burdening toxicity of chemoradiation treatment for the patients, several chemotherapy schedules were attempted. We aimed to search and elucidate high quality evidence available to date to answer our clinical question, whether triweekly or weekly concurrent chemoradiation is better for nasopharyngeal cancer treatment in terms of survival. Methods: Literature searching was conducted on 3 databases: PubMed, EBSCOhost, and Scopus using keyword “Nasopharyngeal Cancer”, “Weekly Chemotherapy”, “Triweekly Chemotherapy”, “Overall Survival” and its synonyms using both MeSH and non-MeSH terms. Critical Appraisal for selected studies was done by 3 different person, using CEBM Critical Appraisals Tools. Results: Six studies were selected to be relevant after elaborate search, which was then critically apprasied and found to be valid. Results from all those 6 studies found that weekly vs. triweekly chemoradiation regimen leads to similar survival outcome in nasopharyngeal cancer patients. Overall Survival (OS) rates from those 6 studies showed comparable result among both regimens (3-Year OS, 91% vs 90.8%; 5-year OS, 89% vs. 91%, 85.6% vs 90%, 78.9% vs 85.2%) and, all OS rate outcomes didn’t reach significant difference for all 6 studies. Conclusions: Weekly and triweekly chemoradiation regimens for nasopharyngeal cancer were shown to be similar in terms of overall survival. The choice of weekly or triweekly chemoradiation for nasopharyngeal cancer patient should tailored according to institutional condition and capability. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
300P
Endoscopic nasopharyngectomy for localized stage I nasopharyngeal carcinoma
M-Y. Chen, L. You-Ping, X. Zou, X. Lv, Y-J. Hua, M-H. Hong Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China Background: The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy (IMRT) as primary curative treatment for newly diagnosed nasopharyngeal carcinoma (NPC), but the radiation-related complications and relatively high medical costs cannot be ignored. We examined whether endoscopic nasopharyngectomy (ENPG) could be an effective alternative treatment for localized stage I NPC. Methods: Ten newly diagnosed localized stage I NPC patients received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center. The survival outcomes, quality of life (QOL), and medical costs were collected. Simultaneously, data for 329 stage I NPC patients treated with IMRT were collected as a reference. Results: After a median follow-up of 59.0 months (95%CI 53.4-64.6), no death, locoregional recurrence, or distant metastasis was observed in the 10 ENPG-treated patients. The 5-year overall survival, local relapse-free survival, regional relapse-free survival and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients (100% vs. 99.1%, 100% vs. 97.7%, 100% vs. 99.0%, 100% vs. 97.4%, respectively, P > 0.05). In addition, compared with IMRT, ENPG was associated with decreased total medical costs ($4090.4261502.65 vs. 12620.8864242.65, P < 0.001) and improved QOL scores including dry mouth (3.3 6 10.5 vs. 34.4 6 25.8, P < 0.001) and sticky saliva (3.3 6 10.5 vs. 32.6 6 23.3, P < 0.001). Conclusions: ENPG alone was associated with promising long-term survival outcomes, low medical costs, and excellent QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients. Legal entity responsible for the study: Mingyuan Chen. Funding: National Natural Science Foundation of China. Disclosure: All authors have declared no conflicts of interest.
doi:10.1093/annonc/mdz428 | ix101
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_9/mdz428.013/5638501 by EKU Libraries user on 04 December 2019
Methods: A retrospective chart review was conducted in South Korea (SK) and Taiwan (TW) to identify patients who initiated first-line systemic therapy for R/M NPC between January 1, 2012 and June 30, 2013. Patients were followed through December 31, 2015. Stratification of study outcomes was performed per location of metastases for patients with distant metastatic disease vs. metastatic disease in distant lymph nodes only. Results: Among 154 R/M NPC patients enrolled across 12 sites, median age was 52 years (interquartile range 45-59), 78% were male, and 87% had ECOG 0-1. In TW (N ¼ 104), all patients had distant metastatic disease either as newly diagnosed metastatic (stage IVc) disease (32%) or disease recurrence with distant metastases (68%). In SK (N ¼ 50), 42% of patients had distant metastatic disease, and 58% presented with distant lymph nodes only. Among patients with distant metastatic disease, patients mainly received systemic therapy only as first-line treatment in both TW (72%) and SK (67%), among which platinum þ 5-FU was most common (34%). Remaining patients with distant metastatic disease received systemic therapy þ radiation (28% TW; 33% SK). In contrast, patients with distant lymph nodes only in SK primarily received systemic therapy þ radiation (83%). Median OS for patients with distant metastatic disease who received systemic therapy only was 23 months (95% confidence interval [CI] 18-32), compared with 32 months (95% CI: 22-Not Determined) for patients who received systemic therapy þ radiation. Median OS was not reached for patients with distant lymph nodes only who received systemic therapy þ radiation. Conclusions: Differences in the location of metastases for patients with R/M NPC led to variation in treatment approaches across TW and SK. Prognosis in patients with distant metastatic disease remains poor with limited therapeutic options, underscoring the need for newer, more efficacious treatments. Legal entity responsible for the study: Merck and Co., Inc. Funding: Merck and Co., Inc. Disclosure: M-J. Ahn: Honoraria (self): Merck Sharpe and Dohme; Honoraria (self): Astra-Zeneca;