Induction plus adjuvant chemotherapy, combined treatment with nimotuzumab, and intensity-modulated radiation therapy for N3 stage nasopharyngeal carcinoma: A pilot study

The main cause of treatment failure in NPC is distant metastasis and the NPC patients with stage N3 are the most prone to develop distant metastases. Thus, the selection of an efficient, lowtoxicity, welltolerated, adequate regimen is the key to improve the therapeutic efficacy for patients with stage N3 NPC.This study aimed to determine the safety and feasibility of induction chemotherapy with nanoparticle albumin-bound paclitaxel (nab-paclitaxel) plus cisplatin, combined treatment with nimotuzumab, and Intensity-modulated radiation therapy (IMRT), followed by S-1 adjuvant chemotherapy for stage N3M0 nasopharyngeal carcinoma (NPC).This retrospective study involved 43 patients with stage N3M0 NPC treated with the above regimens.For induction chemotherapy, four cycles of nab-paclitaxel (260 mg/m2, day 1) plus cisplatin (25 mg/m2, days 1-3) were administered. IMRT was performed concurrently with targeted therapy with nimotuzumab (200 mg IV, weekly for seven courses). For adjuvant chemotherapy, S-1 (40-60 mg twice a day, depending on the patient's body surface area) was administered for 14 days and was stopped for 7 days; this cycle was repeated every 21 days.All statistical analyses were performed using an SPSS v21.0 software package. The LRC, OS, DMFS, and progressionfree survival (PFS) rates were calculated using the Kaplan-Meier method, and differences in these rates were analyzed using logrank test.The total treatment efficiency was 100.0%. The 3-year locoregional control, overall survival, distant metastasis-free survival, and progression-free survival rates were 97.6%, 87.6%, 83.5%, and 81.0%, respectively. Neutropenia was the most common hematological toxicity (95.3%), and the incidence of Grade ≥3 neutropenia was 30.2%. Grade 3 anemia and thrombocytopenia did not occur. The most common nonhematological adverse reactions were mucositis (100.0%), hair loss (100.0%), rashes (65.1%), and limb numbness with pain (60.4%). The occurrence and treatment of skin rashes needed special attention.Induction nab-paclitaxel plus cisplatin, nimotuzumab combined with IMRT, followed by S-1 adjuvant chemotherapy, yielded an excellent survival benefit with tolerable toxicities in patients with stage N3 NPC. Distant metastasis was the main cause of treatment failure.