Multicenter phase 3 trial of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy for stage N2-3 nasopharyngeal cancer

A multicenter phase 3 trial in China compared four cycles of neoadjuvant docetaxel plus cisplatin chemotherapy followed by concurrent chemoradiotherapy (CCRT) for stage N2-3 nasopharyngeal carcinoma with CCRT alone. There were 93 patients in each group. The median follow-up was 76.9 months. The neoadjuvant chemotherapy plus CCRT group had superior outcomes. The five-year distant metastasis free survival was 91.3% versus 78.2% (HR 0.41; p=0.02) and the five-year overall survival was 90.3% versus 82.6% (HR 0.38; p=0.01). Grade 3 or 4 acute toxicities were observed in 65% in the neoadjuvant chemptherapy plus CCRT group and 51% in the CCRT alone group. There were no significant differences between the groups in late toxicity. The authors conclude that four cycles of docetaxel plus cisplatin chemotherapy with CCRT can effectively reduce distant metastasis and improve survival among patients with stage N2-3 nasopharyngeal carcinoma with manageable toxicities.