[鼻咽癌] 誘導性化療對鼻咽癌的效果(2019.6更新)

Induction chemotherapy 對 NPC 的治療一直是一個熱門的話題, induction chemotherapy,中文譯為誘導性化療, 其實就是neoajuvant chemotherapy,只是換個名字而已! 小弟嘗試整理一些相關的trial, 希望之後臨床上遇到能更熟悉

1. 之前失敗的 trial (都是用induction CT + RT v.s. RT)

(1) cisplatin, 5-FU : overall survival, disease-free survival, locoregional relapse rate, distant metastatic rate, and median time to relapse在兩組間都沒差異 (論文連結, 1995)
(2) bleomycin, epirubicin, and cisplatin: induction CT 組在disease-free survival的效果比較好, 但是治療相關的死亡數也比較多, 其他 local, regional metastases, overall survival無明顯差異 (論文連結, 1996)
(3) cisplatin, epirubicin: relapse free survival,overall survival 在兩組間無差異(論文連結, 1998)
(4) cisplatin, bleomycin, 5-FU: 5-year overall survival rates 和 relapse-free survival 無明顯差異(論文連結, 2001)

看完上面一堆失敗的, 接下來就是看近代成功的trial惹

2.  induction CT+CCRT v.s. CCRT

(1) TPF regimen (docetaxel, cisplatin, 5-FU):  中國方面有一個phase 3 trial針對locoregionally advanced nasopharyngeal carcinoma (AJCC 7: stage III-IVB, exclude T3-4N0) 做induction CT, 發現induction CT可以改善3-year failure-free survival (80%v.s. 72%)(論文連結, 2016)
(2) GP regimen(Gemcitabine+ Cisplatin): 很令人振奮, 剛好看到新出來的NEJM, 有這方面的evidence惹(論文點此), 中國廣州中山大學的研究, 也是phase 3, locoregionally advanced nasopharyngeal carcinoma, 分成induction CT(gemcitabine+cisplatin) +CCRT V.S. CCRT alone, 發現 induction chemotherapy組可以改善 3-year recurrence-free survival ( 85.3% v.s 76.5%) (stratified hazard ratio for recurrence or death, 0.51; 95% confidence interval [CI], 0.34 to 0.77; P=0.001). 可以改善 Overall survival at 3 years (94.6% v.s. 90.3%) (stratified hazard ratio for death, 0.43; 95% CI, 0.24 to 0.77)

(3) MEPFL(mitomycin C, epirubicin, cisplatin, and 5-fluorouracil/leucovorin):這篇是台灣本土出產論文,也是phase III trail, 針對stage IVA and IVB 的病人, induction CT可以改善disease free survival (5-year rate 61% versus 50%),但對overall survival無明顯影響(論文連結)




reference:
1.  Handbook of Evidence-Based Radiation Oncology 3rd Edition
2.  Perez & Brady's Principles and Practice of Radiation Oncology