ASCO--The preliminary results of an Intergroup study of patients with locally advanced nasopharyngeal cancer show a highly significant improvement in survival with the use of chemoradia-tion, compared with radiation alone, Muhyi Al-Sarraf, MD, said at the ASCO plenary session.
Median progression-free survival is 13 months on the radiation alone arm and has not been reached in the combination arm, said Dr. Al-Sarraf, of the Providence Cancer Center, Southfield, Michigan.
Three-year progression-free survival is an estimated 65% for the combination therapy arm vs 24% for the radiation only arm (P = .0001). Median survival is 2 years better in the combination arm (60 months vs 34 months), and estimated 3-year survival is 31% better (76% vs 45%, P = .0017.)
Nasopharyngeal carcinoma, although rare in the United States, is common across the world and is especially prevalent in southern China, Southeast Asia, North Africa, the Middle East, and among Eskimos. The incidence in this country may be increasing due to immigration from these areas. Migrants continue to have a higher incidence, even into the second and third generations, he said.
The experimental arm received the same radiation dose as the standard arm plus concurrent cisplatin(Drug information on cisplatin) (Platinol), 100 mg/m² given on day 1 and every 3 weeks for 3 doses. At the end of chemoradiation, patients received an additional three courses of reduced-dose cisplatin and fluorouracil(Drug information on fluorouracil).
At present, 150 patients have been analyzed, the majority with T4 or T3 disease. An important point, Dr. Al-Sarraf said, is that there have been no toxicity-related deaths and no grade 5 toxicity in either arm.
Edward Vokes, MD, of the University of Chicago, said that concurrent cisplatin and radiation followed by adjuvant cis-platin/fluorouracil should now be considered standard therapy for locoregion-ally advanced nasopharyngeal cancer.