Eric J. Sherman, MD, Discusses the Use of Adjuvant Capecitabine in Nasopharynx Cancer

At the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, CancerNetwork® sat down with Eric J. Sherman, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center, to discuss 2 phase 3 studies featuring the use of adjuvant capecitabine following cisplatin and radiation therapy in patients with advanced nasopharynx cancer (NCT02958111; NCT02143388).

In both studies, capecitabine yielded a survival benefit in patients and could possibly represent a new standard of care in this population. However, several questions still need to be answered, including as to whether adjuvant cisplatin plus 5-fluorouracil (5-FU) may be a better option and if induction chemotherapy is needed.

Transcript:

Two studies looked at the question of using capecitabine as adjuvant therapy for nasopharynx cancer, both looking at advanced nasopharynx cancer after cisplatin and radiation. One allowed neoadjuvant therapy, and the other did not. The one thing you saw pretty clearly is that adjuvant capecitabine led to a survival benefit—definitely a progression-free survival benefit, but it looks like an overall survival benefit, [too]. That’s really important. There’s a really big push away from adjuvant chemotherapy. This is showing that using a drug that can be given as a pill, not even [intravenous] treatment, and at reasonable doses, leads to a benefit independent of whether [the patient had] adjuvant therapy or not. These were not the high doses of capecitabine: One [study used] 1000 mg/m2 for 2 weeks on/1 week off, and the other study used just 650 mg/m2 twice a day, continued for a full year…This is something that may be a real [practice] changer in how we treat.

The question is, do we go this capecitabine route? Do we continue to do cisplatin and 5-FU as an adjuvant therapy? Do we need induction chemotherapy plus adjuvant therapy? There are still some questions that exist, but this may easily become a new standard of care for nasopharynx cancer, especially since capecitabine is an easy drug for us to get in the United States. It will be interesting to see how the FDA views both of those clinical studies.

Those are the 2 real potential game changers in the sense that they may change [our] practice [for] head and neck cancer, even in the next month or 2. [However], both of these approaches [have] some controversy and it is going to be something that everyone is going to have to discuss a lot further to figure out what their true role is in standard of therapy.

References

1. Ma J, Chen YP, Sun Y, et al. Metronomic capecitabine as adjuvant therapy in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicenter, randomized controlled trial. J Clin Oncol. 2021;39(suppl 15):6003. doi:10.1200/JCO.2021.39.15_suppl.6003
2. Miao J, Wang L, Tan SH, et al. Adjuvant capecitabine in locoregionally advanced nasopharyngeal carcinoma: a multicenter randomized controlled phase III trial. J Clin Oncol. 2021;39(suppl 15):6005 doi:10.1200/JCO.2021.39.15_suppl.6005