治疗鼻咽癌的低毒性选择：奈达铂化疗

Introduction: A study shows that compared with cisplatin-based chemoradiotherapy, nedaplatin-based concurrent chemoradiotherapy has a similar 5-year survival rate and fewer side effects.

A study in JAMA Network Open showed that when patients with stage II to IVB nasopharyngeal carcinoma received concurrent nedaplatin-based chemoradiation therapy, their 5-year survival rate was comparable to that of patients who received cisplatin-based chemoradiation therapy, but with fewer toxic side effects.

The researchers say these findings confirm that nedaplatin-based chemoradiotherapy can be considered as an alternative to cisplatin for the treatment of stage II to IVB nasopharyngeal carcinoma.

Although the National Comprehensive Cancer Network recommends that patients with stage II to IVB nasopharyngeal carcinoma use 100 mg/m² of cisplatin every 3 weeks concurrently with radiotherapy, adding cisplatin-based chemotherapy during radiotherapy will increase the frequency of treatment-related toxic reactions. Including severe gastrointestinal reactions, hearing impairment, renal toxicity and neurotoxicity, reducing treatment compliance and patients' quality of life. Therefore, patients urgently need an anti-tumor drug that is similar to cisplatin in efficacy but can reduce adverse reactions.

The cisplatin analog nedaplatin is designed to reduce the nephrotoxic and gastrointestinal toxic effects of cisplatin, and its anti-tumor mechanism and efficacy are similar to cisplatin. It has shown efficacy and tolerability in various malignancies and has shown potential as a radiosensitizer for nasopharyngeal and cervical squamous cell carcinoma cells in vitro.

In the initial 2-year results of this phase 3 trial, concurrent nedaplatin-based chemotherapy was noninferior to concurrent cisplatin-based chemotherapy, with differences of 1.9% and 1.0%, respectively, in intention-to-treat and per-protocol analyzes of progression-free survival. Patients (n = 402) were randomly assigned in a 1:1 ratio to receive nedaplatin (100 mg/m²) or cisplatin (100 mg/m²)-based chemotherapy every 3 weeks along with intensity-modulated radiotherapy.

In the current analysis of 402 patients (approximately 25% women, median age 44.5 years), the 5-year progression-free survival rate was 81.4% in the cisplatin group and 79.8% in the nedaplatin group, a difference of 1.6%. There was no significant survival difference between the cisplatin group and the nedaplatin group in terms of 5-year overall survival rate (89.4% vs. 88.8%), distant metastasis-free survival rate (85.9% vs. 90.4%), and local recurrence-free survival rate (92.6% vs. 89.6%).

The incidence of grade 3 and 4 auditory toxicities was higher in the cisplatin group than in the nedaplatin group (35 [17.7%] vs. 21 [10.5%]). In addition, the incidence of grade 3-4 auditory toxicity was higher in the cisplatin group compared with the nedaplatin group (19.9% ​​vs. 12.0%).

These findings confirm that concurrent nedaplatin-based chemotherapy can replace concurrent cisplatin-based chemotherapy as dual therapy for II to IVB nasopharyngeal carcinoma. However, the potential of nedaplatin in combination with pharmacological chemotherapy in the induction or adjuvant phase for the treatment of NPC needs to be explored in further investigation.

References:

https://www.mdedge.com/hematology-oncology/article/251908/head-neck/thyroid-cancers/nedaplatin-chemo-proves-be-less-toxic?channel=39313