By Cameron Johnston
CHICAGO -- June 2, 2008 -- The combination of capecitabine and cisplatin seems to offer an important advantage in terms of overall survival and progression-free survival compared with cisplatin alone for patients with advanced nasopharyngeal cancer (NPC), a study presented here at the American Society of Clinical Oncology (ASCO) 44th Annual Meeting has reported.
The study, presented on June 1, was conducted in Hong Kong, Indonesia, Thailand, and Taiwan, where NPC is a common form of cancer, particularly among younger patients, and accounts for 3.3% of all new cancers annually.
Typically, the first-line treatment for NPC is cisplatin alone, which has an overall response rate in the range of 50% to 60%. More recently, capecitabine has been added as second-line therapy, although in those cases, survival is usually less than 5 months.
Daniel Chua, MD, Department of Oncology, Queen Mary Hospital, Hong Kong, and colleagues enrolled 44 treatment-naive patients and treated them with IV cisplatin 100 mg/m2 on day 1 followed by capecitabine 825 mg/m2 twice daily on days 1 through 14 of a 21-day cycle.
At enrolment, all the patients had a Karnofsky performance status >90, but one-third had stage IV disease and two-thirds had recurrent disease. More than half of patients had nodal involvement and one-third had lung metastasis.
In total, data for 39 patients were analysed and showed a 54% overall response rate with 1 complete response and 20 partial responses. The median time to progression was 6.8 months. At 1 year of follow-up, a median overall survival had not been established; 73% of patients were alive. Median duration of response was 7.2 months.
Of the 39 patients whose data were evaluated, 8 (21%) went on to receive additional therapy after cisplatin/capecitabine. Nine patients went on to receive palliative therapy.
No significant deteriorations in quality of life were reported during and after the dual-therapy treatment.
The combination was generally well tolerated, although 27% of patients developed hand-foot syndrome. The most common grade III/IV adverse events were neutropenia (50%), vomiting (11%), and thrombocytopenia (9%). Two patients developed febrile neutropenia, and 1 died as a result of sepsis that was treatment related.
The authors concluded that the rates of response, disease control, progression-free survival, and overall survival seen with this dual-therapy regimen compared favourably with existing therapies, and that the toxicity profile was generally acceptable.
The regimen also required a shorter hospital stay and was more convenient for the patients compared with regimens such as cisplatin and 5-fluorouracil, according to the researchers. These favourable results indicate that further investigation is warranted, they added.
Funding for this study was provided by Hoffman-LaRoche.
[Presentation title: Phase II Trial of First-Line Capecitabine Plus Cisplatin in Patients With Advanced/Metastatic Nasopharyngeal Cancer (NPC). Poster 6033]
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