The efficacy and safety of induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) in treating patients with locally advanced nasopharyngeal carcinoma

IntroductionThis phase II clinical trial aimed to investigate the efficacy and safety of induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF regimen) followed by concurrent chemoradiation in patients with locally advanced nasopharyngeal carcinoma.MethodsEligible patients were aged 15–70 years and had to have newly diagnosed locally advanced NPC (T3–T4 and/or N2–N3, M0), Karnofsky Performance Status (KPS) ⩾70, and normal or adequate kidney, liver, cardiovascular, and bone marrow functions. All patients were assigned to receive 3 cycles of induction chemotherapy in an outpatient setting every 3 weeks with TPF regimen (docetaxel 75 mg/m2 for day 1, cisplatin 75 mg/m2 for day 1, 5-FU 750 mg/m2/day with 8-h infusion on days 1–3) followed by 7 weeks of concurrent chemoradiation (70 Gy) with weekly cisplatin 30 mg/m2.ResultsOverall, 74 courses of induction chemotherapy were administered. After induction chemotherapy, overall response rate was 84%. However, only one patient achieved a pathologic complete response. At the end of concurrent chemoradiation, 24 patients (96%) achieved clinical and pathologic complete response at both nasopharynx and regional nodes and one (4%) had persistent disease. Treatment-related toxicities were common but manageable. Grade 1–2 anemia was the most hematologic toxicity being detected in 51 cycles (68.9%) of induction chemotherapy. Four patients developed uncomplicated, culture-negative febrile neutropenia. There was no treatment-related death.ConclusionInduction chemotherapy with TPF regimen followed by concurrent chemoradiation is highly effective with manageable toxicity in patients with locally advanced nasopharyngeal carcinoma.