The effect of adjuvant chemotherapy and early tumor regression on the outcome of nasopharyngeal cancer patients treated with concurrent chemoradiotherapy

Oral Oncology ◽  
2021 ◽  
Vol 113 ◽  
pp. 105130
Author(s):  
So Jung Lee ◽  
Yeon-Sil Kim ◽  
Chul Seung Kay ◽  
Myungsoo Kim ◽  
Jin Hyung Kang ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Concurrent Chemoradiotherapy ◽  
Tumor Regression ◽  
Nasopharyngeal Cancer ◽  
Early Tumor

scholarly journals High SPINK4 Expression Predicts Poor Outcomes among Rectal Cancer Patients Receiving CCRT

2021 ◽  
Vol 28 (4) ◽  
pp. 2373-2384
Author(s):  
Tzu-Ju Chen ◽  
Yu-Feng Tian ◽  
Chia-Lin Chou ◽  
Ti-Chun Chan ◽  
Hong-Lin He ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Concurrent Chemoradiotherapy ◽  
Therapeutic Response ◽  
Tumor Regression ◽  
Free Survival ◽  
Cancer Transcriptome ◽  
Poor Outcomes ◽  
Univariate Analyses ◽  
Local Recurrence Free Survival

Background: Patients with rectal cancer can prospectively be favored for neoadjuvant concurrent chemoradiotherapy (CCRT) to downstage before a radical proctectomy, but the risk stratification and clinical outcomes remain disappointing. Methods: From a published rectal cancer transcriptome dataset (GSE35452), we highlighted extracellular matrix (ECM)-linked genes and identified the serine protease inhibitor Kazal-type 4 (SPINK4) gene as the most relevant among the top 10 differentially expressed genes associated with CCRT resistance. We accumulated the cases of 172 rectal cancer patients who received neoadjuvant CCRT followed by surgery and collected tumor specimens for the evaluation of the expression of SPINK4 using immunohistochemistry. Results: The results revealed that high SPINK4 immunoexpression was significantly related to advanced pre-CCRT and post-CCRT tumor status (both p < 0.001), post-CCRT lymph node metastasis (p = 0.001), more vascular and perineurial invasion (p = 0.015 and p = 0.023), and a lower degree of tumor regression (p = 0.001). In univariate analyses, high SPINK4 immunoexpression was remarkably correlated with worse disease-specific survival (DSS) (p < 0.0001), local recurrence-free survival (LRFS) (p = 0.0017), and metastasis-free survival (MeFS) (p < 0.0001). Furthermore, in multivariate analyses, high SPINK4 immunoexpression remained independently prognostic of inferior DSS and MeFS (p = 0.004 and p = 0.002). Conclusion: These results imply that high SPINK4 expression is associated with advanced clinicopathological features and a poor therapeutic response among rectal cancer patients undergoing CCRT, thus validating the prospective prognostic value of SPINK4 for those patients.

scholarly journals Improved Overall Survival and Decreased Metastasis With Adjuvant 5-Fluorouracil and Platinum Chemotherapy After Definitive Concurrent Chemoradiotherapy for N3 Nasopharyngeal Cancer: A Registry-Based Analysis

2021 ◽  
Author(s):  
Mu-Hung Tsai ◽  
Shang-Yin Wu ◽  
Tsung Yu ◽  
Sen-Tien Tsai ◽  
Yuan-Hua Wu
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Distant Metastasis ◽  
Concurrent Chemoradiotherapy ◽  
Locally Advanced ◽  
Nasopharyngeal Cancer ◽  
Disease Free Survival ◽  
Free Survival ◽  
Risk Of Death

Abstract Background and purpose Concurrent chemoradiotherapy is the established treatment for locally advanced nasopharyngeal carcinoma (NPC). However, there is no evidence supporting routine adjuvant chemotherapy. We aimed to demonstrate the effect of adjuvant chemotherapy on survival and distant metastasis in high-risk N3 NPC patients. Materials and methods We linked the Taiwan Cancer Registry and Cause of Death database to obtain data. Clinical N3 NPC patients were divided as those receiving definitive concurrent chemoradiotherapy (CCRT) with adjuvant 5-fluorouracil and platinum (PF) chemotherapy and those receiving no chemotherapy after CCRT. Patients receiving neoadjuvant chemotherapy were excluded. We compared overall survival, disease-free survival, local control, and distant metastasis in both groups using Cox proportional hazards regression analysis. Results We included 431 patients (152 and 279 patients in the adjuvant PF and observation groups, respectively). Median follow-up was 4.3 years. The 5-year overall survival were 69.1% and 57.4% in the adjuvant PF chemotherapy and observation groups, respectively (p = 0.02). Adjuvant PF chemotherapy was associated with a lower risk of death (hazard ratio [HR] = 0.61, 95% confidence interval [CI]: 0.43–0.84; p = 0.003), even after adjusting for baseline prognostic factors (HR = 0.61, 95% CI: 0.43–0.86; p = 0.005). Distant metastasis-free survival at 12 months was higher in the adjuvant PF chemotherapy group than in the observation group (98% vs 84.8%; p < 0.001). After adjusting for baseline prognostic factors, adjuvant PF chemotherapy was associated with freedom from distant metastasis (HR = 0.11, 95% CI: 0.02–0.46; p = 0.003). Conclusion Prospective evaluation of adjuvant PF chemotherapy in N3 NPC patients treated with definitive CCRT is warranted because adjuvant PF chemotherapy was associated with improved overall survival and decreased risk of distant metastasis.

Applying the ASCO and ESMO Value Frameworks to nasopharyngeal cancer treatments: Is adding induction chemotherapy or adjuvant chemotherapy to concurrent chemoradiotherapy worthwhile?

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 67-67
Author(s):  
Teng Hwee Tan ◽  
Yu Yang Soon ◽  
Timothy Cheo ◽  
Lea Choung Wong ◽  
Yiat Horng Leong ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Induction Chemotherapy ◽  
Concurrent Chemoradiotherapy ◽  
Locally Advanced ◽  
Wholesale Price ◽  
Nasopharyngeal Cancer ◽  
Health Benefit ◽  
Concurrent Chemotherapy ◽  
Drug Costs ◽  
Phase Iii

67 Background: To determine and compare the incremental clinical benefit (ICB) and costs of induction chemotherapy (IC) when added to concurrent chemoradiotherapy (CCRT), concurrent chemotherapy (CC) added to RT and CC + adjuvant chemotherapy (AC) when added to RT for locally advanced nasopharyngeal cancer (LA-NPC). Methods: We searched phase III randomized controlled trials (RCTs) which reported overall survival (OS) benefit with the use of IC, CC and CC+AC in LA-NPC. We quantified the ICB using the ASCO and ESMO value framework. We calculated the incremental drug costs in US dollars using the lowest average wholesale price reported in the Lexicomp drug database. Results: We identified three RCTs on IC, three RCTs on CC and four RCTs on CC + AC. The ICB was judged to be Grade A based on the ESMO framework. The ASCO Net Health Benefit Score (NHBS) ranged from 17.43 to 57.39. The incremental drug costs ranged from 133.46 to 626.14. There were no statistically significant differences in the means of NHBS [39.37 (IC) vs 37.61 (CC) vs 33.98 (CC+AC), P = 0.89] and costs [383 (IC) vs 253 (CC) vs 460 (CC+AC), P = 0.27] between these three approaches. There was no statistically significant correlation between ICB and costs. Conclusions: The magnitudes of ICB and incremental drug costs of adding of IC to CCRT, CC to RT and CC + AC to RT for LA NPC are not significantly different.

Applying the ASCO and European Society for Medical Oncology Value Frameworks to Nasopharyngeal Cancer Treatments: Is Adding Induction Chemotherapy or Adjuvant Chemotherapy to Concurrent Chemoradiotherapy Worthwhile?

2020 ◽  
Vol 16 (11) ◽  
pp. e1386-e1396
Author(s):  
Teng Hwee Tan ◽  
Yu Yang Soon ◽  
Timothy Cheo ◽  
Lea Choung Wong ◽  
Yiat Horng Leong ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Induction Chemotherapy ◽  
European Society ◽  
Concurrent Chemoradiotherapy ◽  
Medical Oncology ◽  
Locally Advanced ◽  
Nasopharyngeal Cancer ◽  
Health Benefit ◽  
Drug Costs ◽  
Phase Iii

PURPOSE: To determine and compare the incremental clinical benefit (ICB) and costs of induction chemotherapy (IC) when added to concurrent chemoradiotherapy (CCRT), concurrent chemotherapy (CC) when added to radiotherapy (RT), and CC plus adjuvant chemotherapy (AC) when added to RT for locally advanced nasopharyngeal cancer (LA-NPC). MATERIALS AND METHODS: We searched phase III randomized controlled trials (RCTs) that reported overall survival benefit with the use of IC, CC, and CC + AC in LA-NPC. We quantified the ICB using the ASCO and European Society for Medical Oncology (ESMO) value frameworks. We calculated the incremental drug costs in US dollars using the lowest average wholesale price reported in the Lexicomp drug database. RESULTS: We identified three RCTs on IC, three RCTs on CC, and four RCTs on CC + AC. The ICB was judged to be grade A based on the ESMO framework. The ASCO Net Health Benefit score ranged from 17.43 to 57.39. The incremental drug costs ranged from $133.46 to $626.14. There were no statistically significant differences in the mean Net Health Benefit scores (39.37 for IC v 37.61 for CC v 33.98 for CC + AC; P = .89) and costs ($383 for IC v $253 for CC v $460 for CC + AC; P = .27) between the three approaches. There was no statistically significant correlation between ICB and costs. CONCLUSION: The magnitudes of ICB and incremental drug costs of adding of IC to CCRT, CC to RT, and CC + AC to RT for LA-NPC are not significantly different.

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