Comparison of five cisplatin-based regimens frequently used as the first-line protocols in metastatic nasopharyngeal carcinoma

Abstract

Background and objective: No randomized trial has been reported comparing different chemotherapy regimens on disseminated nasopharyngeal carcinoma (NPC). This study aims to compare five cisplatin-based regimens including cisplatin + 5-fluororacil (PF), paclitaxel + cisplatin (TP), gemcitabine + cisplain (GP), paclitaxel + cisplatin + 5-fluororacil (TPF), and bleomycin + cisplatin + 5-fluororacil (BPF) regimen most frequently used as the first-line protocols for metastatic NPC retrospectively.

Methods: Eight hundred and twenty-two patients with metastatic NPC were divided into five groups according to the regimen they received. Then, their response rate, toxicity, and long-term survival outcome as well as the prognostic factors were analyzed.

Results: The higher response rates in GP and TPF regimens comparing to PF regimen were achieved (Χ (2) = 4.57, P = 0.033; Χ (2) = 7.04, P = 0.008), as well as in TPF regimen comparing to TP regimen (Χ (2) = 5.579, P = 0.018). The occurrence rate of the major III-IV grade toxicity was significantly different between the five groups. However, no statistically significant difference was observed in progression-free survival (PFS; P = 0.247) and overall survival (P = 0.127) among the five groups. Cox multivariate analysis identified the following independent prognostic factors: liver metastases, plasma Epstein Barr Virus (EBV)-DNA level, cycles of chemotherapy, and second-line chemotherapy.

Conclusions: PF, TP, and GP are all effective regimens as the first-line chemotherapy for metastatic NPC, which can be well tolerated. Over four cycles of chemotherapy are recommended under no contraindication. Patients should transfer to the second-line regimen after the treatment failure of the first-line chemotherapy.

Fig. 1

a Kaplan–Meier progression-free survival (PFS) curves of 822 patients with metastatic NPC treated with PF, TP, GP, BPF, or TPF regimen. Median PFS ± SE (95 % CI) was 5.0 ± 0.6 (3.9–6.1) months in the PF group, 5.5 ± 0.5 (4.4–6.6) months in the TP group, 6.6 ± 0.6 (5.4–7.8) months in the GP group, 5.5 ± 0.6 (4.4–6.6) months in the BPF group, and 6.0 ± 0.4 (5.1–6.9) months in the TPF group. P = 0.247. b Kaplan–Meier overall survival (OS) curves of 822 patients with metastatic NPC treated with PF, TP, GP, BPF, or TPF regimen. Median OS ± SE (95 % CI) was 19.5 ± 1.2 (17.1–21.9) months in the PF group, 21.0 ± 1.5 (18.1–23.9) months in the TP group, 21.5 ± 1.4 (18.7–24.3) months in the GP group, 19.0 ± 1.3 (16.5–21.5) months in the BPF group, and 21.0 ± 1.6 (18.0–24.0) months in the TPF group. P = 0.127

Fig. 2

a Kaplan–Meier overall survival (OS) curves of 822 patients with metastatic NPC treated with two-drug or three-drug combined regimen. Median OS ± SE (95 % CI) was 20.5 ± 0.7 (19.1–21.9) months in the two-drug combined group and 20.5 ± 1.0 (18.6–22.4) months in the three-drug combined group. P = 0.327. b Kaplan–Meier overall survival (OS) curves of 822 patients with metastatic NPC treated with paclitaxel-included or paclitaxel-free regimen. Median OS ± SE (95 % CI) was 21.5 ± 0.8 (19.8–23.2) months in the paclitaxel-included group, 19.5 ± 0.8 (17.9–21.1) months in the paclitaxel-free group. P = 0.459. c Kaplan–Meier overall survival (OS) curves of 822 patients with metastatic NPC treated with 5-FU-included or 5-FU-free regimen. Median OS ± SE (95 % CI) was 20.0 ± 0.8 (18.4–21.6) months in the 5-FU-included group and 21.0 ± 0.9 (19.2–22.8) months in the 5-FU-free group. P = 0.736. d Kaplan–Meier overall survival (OS) curves of 822 patients with metastatic NPC treated with gemcitabine-included or gemcitabine-free regimen. Median OS ± SE (95 % CI) was 21.0 ± 1.6 (18.0–24.0) months in the gemcitabine-included group and 20.0 ± 0.8 (18.5–21.5) months in the gemcitabine-free group. P = 0.511