The Optimal Cumulative Cisplatin Dose in Nasopharyngeal Carcinoma Patients Receiving Additional Induction Chemotherapy

Summary

To clarify the optimal cumulative cisplatin dose (CCD) in locoregionally-advanced nasopharyngel carcinoma (NPC) patients receiving induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT). Using the NPC-specific database from the established big-data intelligence platform at Sun Yat-Sen University Cancer Center, 583 non-disseminated, locoregionally-advanced NPC patients receiving IC plus CCRT were enrolled. Propensity score matching (PSM) analysis was conducted to control for confounding factors.The median CCD was 160 mg/m² after IC (range, 40–300mg/m²); only 74 patients (12.7%) achieved CCD>200 mg/m². Patients receiving>200 mg/m² CCD did not show significantly improved 5-year overall survival (OS) (HR=1.19; 95% confidence intervals [CI] 0.69–2.06,P=0.53) and progression-free survival (PFS) (HR=1.03; 95% CI 0.63–1.68,P=0.92) compared with patients receiving<200 mg/m² CCD. Further investigations of the potential of median CCD (160 mg/m²) to yield survival benefits revealed that there were no significant differences in survival endpoints between patients receiving CCD>160 mg/m² and CCD<160 mg/m² in both the original and PSM cohorts. Additionally, subgroup analysis indicated a favourable PFS, but not OS, with higher cisplatin administration in patients with pretreatment Epstein–Barr virus deoxyribonucleic acid (EBV DNA)<1000 copies/ml (HR=0.26, 95% CI 0.07–0.93,P=0.03) and receiving<3 IC cycles (HR=0.59, 95% CI 0.33–1.07,P=0.08). Our analysis of real world data provided references for the optimal CCD in locoregionally-advanced NPC receiving additional IC. The causal relationship between 200 mg/m² CCD and improved survival was not defined; 160 mg/m² CCD might be enough. However, for patients with EBV DNA<1000 copy/ml, and receiving<3 IC cycles, higher dose might be necessary.

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