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Gemcitabine combined with cisplatin vs. taxane, cisplatin, and fluorouracil in the treatment of locally advanced nasopharyngeal carcinoma: a retrospective case-control study

Objective: Reports of the efficacy of induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) on locoregionally advanced nasopharyngeal carcinoma (NPC) are scarce. This study aimed to compare the clinical outcomes of the GP (gemcitabine plus cisplatin) regimen and the TPF (taxane, cisplatin and 5-FU) regimen combined with CCRT in patients with NPC.

Patients and methods: This study retrospectively analyzed 827 patients with advanced NPC who received IC combined with CCRT in People's Hospital of Rizhao, China from January 2006 to June 2012. The propensity score method was used to reduce the effects of the observed confounding between the GP and TPF groups. Study end points were disease-free survival (DFS) and overall survival (OS). In total, 694 patients received GP or TPF as the IC treatment program. Propensity score matching identified 166 patients in each cohort.

Results: The 5-year OS and DFS rates of the entire cohort were 83.5% and 80.9%, respectively. GP was associated with a significantly improved 5 year OS (87.4% vs. 79.2%, p< 0.001), and DFS (86.2% vs. 78.5%, p< 0.001) rates compared with the TPF group. In the PSM (propensity score-matching) cohort, the GP group showed a significantly better OS (HR, 1.842, 95% CI:1.627-2.588; p= 0.011), and DFS (HR, 1.904, 95% CI: 1.742-2.737; p= 0.004) compared with the TPF group in multivariable analyses. The prevalence of acute adverse events of neutropenia and leukopenia were higher in severe (grade 3-4) adverse blood events in the TPF group (p<0.05). Thrombocytopenia had more adverse reactions in the GP group (p<0.05). The main non-hemotoxicities were nausea and vomiting, while the TPF group was slightly higher (p=0.031).

Conclusions: The clinical efficacy of the GP regimen combined with CCRT for the treatment of locoregionally advanced NPC may be better than that of the TPF regimen.

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