Theranostics 2017; 7(8):2314-2324. doi:10.7150/thno.19710

Research Paper

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

Rui You1, 2*, Yi-Jun Hua1, 2*, You-Ping Liu1, 2*, Qi Yang1, 2*, Yi-Nuan Zhang1, 2, Ji-Bin Li2, 3, Chao-Feng Li2, 4, Xiong Zou1, 2, Tao Yu1, 2, Jing-Yu Cao1, 2, Meng-Xia Zhang1, 2, Rou Jiang1, 2, Rui Sun1, 2, Hao-Yuan Mo1, 2, Ling Guo1, 2, Ka-Jia Cao1, 2, Ai-Hua Lin5, Ying Sun1, 6, Chao-Nan Qian1, 2, Jun Ma1, 6, Ming-Yuan Chen1, 2 ✉

1. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P. R. China;
2. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center
Guangzhou 510060, P. R. China
3. Department of Clinical Research, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P. R. China;
4. Department of Information Technology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P. R. China;
5. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Second Road, Guangzhou 510080, P. R. China;
6. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P. R. China.
* Rui You, Yi-Jun Hua, You-Ping Liu, Qi Yang contributed equally to this study.

Abstract

We examined the benefits of the combination of anti-EGFR targeted treatment, cetuximab (CTX) or nimotuzumab (NTZ) and concurrent platinum-based chemoradiotherapy (CCRT) compared with CCRT alone in patients with stage II - IVb nasopharyngeal carcinoma (NPC). A total of 1,628 eligible patients with stage II - IVb NPC, who received CCRT (three cycles of 100 mg/m2 cisplatin every 3 weeks with intensity-modulated radiotherapy) with or without CTX or NTZ between June 2009 and December 2013 were included in the analysis. Using propensity scores to adjust for potential prognostic factors, a well-balanced cohort of 878 patients was created by matching each patient who received CTX or NTZ plus CCRT with no more than four patients who received CCRT alone (1:4). Efficacy and safety were compared between CTX/NTZ plus CCRT and CCRT alone arms. Compared with CCRT alone, treatment with CTX/NTZ plus CCRT was associated with a significantly increased overall survival (3-year OS, 96.6% vs. 92.9%, P = 0.015), improved disease-free survival (3-year DFS, 93.5% vs 86.9%, P = 0.028), and improved distant metastasis-free survival (3-year DMFS, 94.6% vs 89.3%, P = 0.030). Increased rate of CTX related-skin reaction and mucositis was observed in the CTX plus CCRT arm. Multivariate analysis demonstrated the combination of CTX/NTZ was a significant protective factor for OS, DFS, and DMFS in patients treated with CCRT. Our analysis suggests that the addition of CTX/NTZ to CCRT is more effective for maximizing survival in patients with stage II-IVb NPC compared with CCRT alone.

Keywords: nasopharyngeal carcinoma, IMRT, concurrent chemoradiotherapy, nimotuzumab, cetuximab, survival outcome, adverse events.

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How to cite this article:
You R, Hua YJ, Liu YP, Yang Q, Zhang YN, Li JB, Li CF, Zou X, Yu T, Cao JY, Zhang MX, Jiang R, Sun R, Mo HY, Guo L, Cao KJ, Lin AH, Sun Y, Qian CN, Ma J, Chen MY. 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(8):2314-2324. doi:10.7150/thno.19710. Available from http://www.thno.org/v07p2314.htm