Yu Zi-Kun, Chen Xu-Yin, Liu Si-Han, Liu You-Ping, You Rui, Huang Pei-Yu
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China.
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, China.
Front Oncol. 2021 Dec 17;11:814881. doi: 10.3389/fonc.2021.814881. eCollection 2021.
OBJECTIVE: Anti-EGFR Targeted agents were found to be capable of modulating the antitumor immunity in head and neck cancer and become more and more frequently used in the treatment of nasopharyngeal carcinoma(NPC). We aimed to explore whether adding concurrent chemotherapy influences the survival outcome of patients with stage II-IVb NPC treated with concurrent anti-EGFR agents and intensity-modulated radiation therapy (IMRT) and explore other prognostic factors for the patients. MATERIALS AND METHODS: A total of 656 stage II-IVb NPC patients treated with concurrent anti-EGFR agents plus IMRT between January 2011 and November 2015 were enrolled. Firstly, from these patients, a well-balanced cohort of 302 patients who received concurrent chemotherapy was created by matching potential prognostic factors. Furthermore, for all 656 stage II-IVb NPC patients, univariate and multivariate analyses of overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRRFS) and distant metastasis-free survival (DMFS) were conducted to identify prognostic factors and to confirm the findings from the matching cohort. RESULTS: Compared with concurrent anti-EGFR agents alone, combining concurrent cisplatin and anti-EGFR agents significantly improved the OS (5-year 94.7% versus 84.3%, P=0.012) and PFS (5-year 82.0% versus 71.7%, P=0.039) of NPC patients with more severe hematologic toxicity and mucositis. The independent prognostic factors identified by multivariate analysis of OS and PFS included concurrent chemotherapy, epstein-barr virus(EBV) status and clinical stage. Patients treated without induction chemotherapy (IC) may achieve more benefits from the addition of concurrent chemotherapy to concurrent anti-EGFR agents. CONCLUSIONS: For stage II-IVb NPC patients treated with concurrent anti-EGFR agents, the addition of concurrent chemotherapy can significantly improve the survival outcome.
目的:抗表皮生长因子受体(EGFR)靶向药物被发现能够调节头颈癌的抗肿瘤免疫,并且越来越频繁地用于鼻咽癌(NPC)的治疗。我们旨在探讨同步化疗是否会影响接受同步抗EGFR药物和调强放疗(IMRT)的II-IVb期NPC患者的生存结局,并探索这些患者的其他预后因素。 材料与方法:纳入2011年1月至2015年11月期间接受同步抗EGFR药物加IMRT治疗的656例II-IVb期NPC患者。首先,从这些患者中,通过匹配潜在的预后因素,创建了一个由302例接受同步化疗的患者组成的均衡队列。此外,对所有656例II-IVb期NPC患者进行总生存(OS)、无进展生存(PFS)、局部区域无复发生存(LRRFS)和远处转移无复发生存(DMFS)的单因素和多因素分析,以确定预后因素并证实匹配队列的结果。 结果:与单纯同步抗EGFR药物相比,同步顺铂和抗EGFR药物联合使用显著改善了NPC患者的OS(5年生存率94.7%对84.3%,P=0.012)和PFS(5年生存率82.0%对71.7%,P=0.039)),但血液学毒性和粘膜炎更严重。通过对OS和PFS的多因素分析确定的独立预后因素包括同步化疗、爱泼斯坦-巴尔病毒(EBV)状态和临床分期。未接受诱导化疗(IC)的患者在同步抗EGFR药物中添加同步化疗可能会获得更多益处。 结论:对于接受同步抗EGFR药物治疗的II-IVb期NPC患者,添加同步化疗可显著改善生存结局。
Transl Cancer Res. 2023-4-28
J Natl Compr Canc Netw. 2020-7