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Childhood Nasopharyngeal Carcinoma: Role of Induction Chemotherapy and Concurrent Chemoradiotherapy

By: Nahae Kim, MPH
Posted: Tuesday, January 21, 2020

Induction chemotherapy and concurrent chemotherapy adapted from adult regimens appear to yield high survival estimates in the treatment of childhood nasopharyngeal carcinoma, according to recent findings published in the Journal of Clinical Oncology. Clinical trials that include a broader age spectrum and consider the special features of this younger patient population are needed, according to the investigators, to improve treatment options.

“We have reported the largest prospective trial for childhood nasopharyngeal carcinoma, to our knowledge, we have further defined the differences between this unique age group and adults, and we have shown among the highest survival estimates—close to 90% at 5 years—using a combination of induction chemotherapy and concurrent chemotherapy,” revealed Carlos Rodriguez-Galindo, MD, of the St. Jude Children’s Research Hospital in Memphis, Tennessee, and colleagues.

In this single-arm trial, 111 pediatric patients with nasopharyngeal carcinoma (World Health Organization type II and III) were enrolled to receive varying degrees of induction therapy and chemoradiotherapy consisting of cisplatin and fluorouracil. Nearly half of the patients included were African American. A response-based approach was used, as patients with complete or partial response after induction chemotherapy received a dose of 61.2 Gy to the nasopharynx and neck, and those with stable disease received 71.2 Gy.

The 2-year and 5-year event-free survival estimates were 86.9% and 84.3%, respectively. The 5-year event-free survival estimates for patients with stages IIb, III, and IV were 100%, 82.8%, and 82.7%, respectively. The 5-year cumulative incidence estimates of local, distant, and combined relapse were 3.7%, 8.7%, and 1.8%, respectively. Patients treated with three versus two concurrent chemoradiotherapy cycles of cisplatin had improved 5-year postinduction event-free survival (90.7% vs 81.2%, P = .14). The most common grade 3 or 4 adverse events among patients receiving three cycles of cisplatin included mucositis oral, nausea, anorexia, decreased white blood cell count, and decreased neutrophil count.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

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