[Phase I study of capecitabine with concurrent radiotherapy in early-stage nasopharyngeal carcinoma].
OBJECTIVE
To evaluate the dose-limiting toxicity (DLT), efficacy and maximum tolerated dose (MTD) of capecitabine with concurrent radiotherapy in patients with node-positive stage II nasopharyngeal cancer.


METHODS
From August 2002 to June 2003, 30 patients with node-positive stage II T(2)N(1)M(0) nasopharyngeal cancer were retrospectively reviewed. Median age 43 years (range 32 - 63 years), ECOG performance status <or= 2. Radiotherapy of 68 - 72 Gy/34 - 36 fractions was delivered to the nasopharynx and 64 - 70 Gy/32 - 35 fractions to the node-positive area. Capecitabine was administered orally on day 1 of radiotherapy by an intermittent schedule (14 days treatment; 7-day rest) at 3 weekly intervals for two cycles. Patients were alloted into one of four escalating dose cohorts (500, 750, 1000 and 1250 mg/m(2), bid). Dose escalation was done after six patients had completed 2 cycles of chemotherapy at the previous dose level with DLT assessed.


RESULTS
Twenty-eight patients were evaluable for toxicity and efficacy: CR 12 (42.9%), PR 13 (46.4%), SD 3 (10.7%), the overall response rate (CR + PR) was 89.3%. The CR response rate of the node-positive area and of the nasopharynx were 50.0% (14/28) and 46.4% (13/28). No DLT was observed at the dosage group of 500 mg/m(2) and 750 mg/m(2). Three of 9 patients experienced DLT at 1000 mg/m(2) with grade III stomatitis; 4 of 6 at 1250 mg/m(2) with grade III stomatitis (4/6), grade III diarrhea with grade IV febrile neutropenia (1/6) and grade III thrombocytopenia (1/6). The toxicity of grade I and II was hand-foot syndrome (4/28), fatigue (14/28), nausea and vomiting (19/28), diarrhea (5/27), and weight loss (21/28).


CONCLUSIONS
A dose of 750 mg/m(2) of capecitabine might be recommended for combination with radiotherapy. This regimen is tolerable and valid for nasopharyngeal carcinoma. A randomised phase III comparison with 5-Fu is justified.
Department of Nasopharyngeal Cancer, Cancer Center, Sun Yat-Sen University, Guangzhou 510060, China.
Ling
L
Guo
Huan-xin
HX
Lin
Feng-yan
FY
Li
Qun
Q
Li
Fang
F
Qiu
Dong-hua
DH
Luo
Xiang
X
Guo
Ming-huang
MH
Hong
D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D000069287:Capecitabine; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D013280:Stomatitis / Q000139:chemically induced; D013921:Thrombocytopenia / Q000139:chemically induced
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil