Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
Cancer Commun (Lond). 2020 Jan;40(1):32-42. doi: 10.1002/cac2.12004. Epub 2020 Feb 29.
Capecitabine was previously used as a second-line or salvage therapy for metastatic nasopharyngeal carcinoma (NPC) and has shown satisfactory curative effect as maintenance therapy in other metastatic cancers. This study aimed to explore the role of capecitabine as maintenance therapy in de novo metastatic NPC patients with different plasma Epstein-Barr virus (EBV) DNA levels before treatment.
We selected de novo metastatic NPC patients treated with locoregional radiotherapy (LRRT) for this retrospective study. The propensity score matching (PSM) was applied to balance potential confounders between patients who underwent capecitabine maintenance therapy and those who did not with a ratio of 1:3. Overall survival (OS) was the primary endpoint. The association between capecitabine maintenance therapy and survival was assessed using the log-rank test and a Cox proportional hazard model.
Among all patients eligible for this study, 64 received capecitabine maintenance therapy after LRRT. After PSM, 192 patients were identified in the non-maintenance group. In the matched cohort, patients treated with capecitabine achieved a higher 3-year OS rate compared with patients in the non-maintenance group (68.5% vs. 61.8%, P = 0.037). Multivariate analysis demonstrated that capecitabine maintenance therapy was an independent prognostic factor. In subgroup analysis, 3-year OS rate was comparable between the maintenance and non-maintenance groups in patients with high pretreatment EBV DNA levels (˃30,000 copies/mL) (54.8% vs. 45.8%, P = 0.835), whereas patients with low pretreatment EBV DNA levels (≤30,000 copies/mL) could benefit from capecitabine maintenance therapy in OS (90.0% vs. 68.1%, P = 0.003).
Capecitabine maintenance therapy may be superior to non-maintenance therapy in prolonging OS for de novo metastatic NPC patients with pretreatment EBV DNA ≤ 30,000 copies/mL.
卡培他滨先前被用作转移性鼻咽癌（NPC）的二线或挽救性治疗，并且在其他转移性癌症中作为维持治疗显示出令人满意的疗效。本研究旨在探讨卡培他滨作为维持治疗在不同治疗前血浆 Epstein-Barr 病毒（EBV）DNA 水平的初治转移性 NPC 患者中的作用。
我们选择了接受局部区域放射治疗（LRRT）的初治转移性 NPC 患者进行这项回顾性研究。应用倾向评分匹配（PSM）来平衡接受卡培他滨维持治疗的患者与未接受治疗的患者之间的潜在混杂因素，比例为 1:3。总生存期（OS）是主要终点。使用对数秩检验和 Cox 比例风险模型评估卡培他滨维持治疗与生存之间的关系。
在所有符合本研究条件的患者中，64 例患者在 LRRT 后接受了卡培他滨维持治疗。经过 PSM 后，非维持组中确定了 192 例患者。在匹配队列中，与非维持组相比，接受卡培他滨治疗的患者 3 年 OS 率更高（68.5% vs. 61.8%，P=0.037）。多因素分析表明，卡培他滨维持治疗是独立的预后因素。亚组分析显示，在 EBV DNA 水平较高（＞30,000 拷贝/mL）的患者中，维持组与非维持组的 3 年 OS 率相当（54.8% vs. 45.8%，P=0.835），而 EBV DNA 水平较低（≤30,000 拷贝/mL）的患者从卡培他滨维持治疗中获益 OS（90.0% vs. 68.1%，P=0.003）。
对于 EBV DNA 水平≤30,000 拷贝/mL 的初治转移性 NPC 患者，卡培他滨维持治疗可能优于非维持治疗，可延长 OS。
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