title: Effects of induction docetaxel, platinum, and fluorouracil chemotherapy in patients with stage III or IVA/B nasopharyngeal cancer treated with concurrent chemoradiation therapy: Final results of 2 parallel phase 2 clinical trials.
abstract: BACKGROUND
  The effects of docetaxel, platinum, and fluorouracil (TPF) induction chemotherapy plus concurrent chemoradiotherapy (CCRT) on locoregionally advanced nasopharyngeal cancer (NPC) are unclear. This study examined the long-term outcomes of the addition of this regimen to CCRT for stage III and IVA/B NPC.
  
  
  METHODS
  Two parallel, single-arm phase 2 trials were performed synchronously to evaluate the efficacy and toxicity of TPF-based induction chemotherapy in patients with stage III or IVA/B NPC. The induction chemotherapy, which preceded standard intensity-modulated radiation therapy/platinum-based chemoradiation, consisted of 3 cycles of docetaxel (75 mg/m2on day 1), cisplatin (75 mg/m2on day 1), and a continuous infusion of fluorouracil (500 mg/m2/d on days 1-5) every 4 weeks. The primary endpoint for both trials was 5-year overall survival (OS).
  
  
  RESULTS
  Between January 2007 and July 2010, 52 eligible patients with stage III NPC and 64 eligible patients with nonmetastatic stage IV NPC were accrued to the 2 trials. With a median follow-up of 67 months, the 5-year OS, progression-free survival, distant metastasis-free survival, and local progression-free survival (LPFS) rates were all improved in comparison with historical benchmarks for patients with stage III or IVA/IVB NPC. Multivariate analyses indicated that T and N classifications (T1/T2 vs T3/T4 and N3 vs N0-N2) were the only significant prognosticators for OS. The number of induction chemotherapy cycles was the only significant prognostic factor for predicting LPFS.
  
  
  CONCLUSIONS
  TPF-based induction chemotherapy appears to significantly improve outcomes in comparison with historical data when it is administered before CCRT for locoregionally advanced NPC. A phase 3 trial is currently being performed to confirm this benefit. Cancer 2017;123:2258-2267. © 2017 American Cancer Society.
authors.affiliation: Department of Radiation Oncology, Shanghai Proton and Heavy-Ion Center, Fudan University Shanghai Cancer Hospital, Shanghai, China.|Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Kong
authors.affiliation: Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.
authors.forename: Youwang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.
authors.forename: Chaosu
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of Medical Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, Shanghai Proton and Heavy-Ion Center, Fudan University Shanghai Cancer Hospital, Shanghai, China.
authors.forename: Jiade J
authors.initials: JJ
authors.lastname: Lu
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil
keywords: intensity-modulated radiation therapy; nasopharyngeal cancer; neoadjuvant chemotherapy; taxane