Nedaplatin good alternative treatment to cisplatin in nasopharyngeal carcinoma patients: JAMA

China: Long-term analysis revealed that nedaplatin-based concurrent chemoradiotherapy (CCRT) might be regarded as an alternate doublet treatment method to cisplatin-based CCRT in stage II to IVB nasopharyngeal carcinoma (NPC). The study was done by Qing-Nan Tang and colleagues and published in the Journal of American Medical Association on 10th December 2021.

At 2 years, a nedaplatin-based CCRT regimen was non-inferior to a cisplatin-based regimen in patients with locoregional, stage II to IVB NPC and was linked with fewer late adverse events, although long-term results and toxicity remain unknown. Therefore this study was conducted with the objective to look at the 5-year results and late toxicity profile of nedaplatin-based CCRT in patients with locoregional, stage II to IVB NPC.

Between January 16, 2012, and July 16, 2014, patients with nonkeratinizing stage II to IVB NPC were included in this 5-year follow-up secondary analysis of an open-label, noninferiority, multicenter randomized clinical trial, with a median follow-up period of 78 months (IQR, 3-99 months). The data was analyzed between November 10, 2020, and July 8, 2021. Patients were randomly allocated (1:1) to receive either nedaplatin (100 mg/m2) or cisplatin (100 mg/m2)-based chemotherapy every three weeks for three cycles, in addition to intensity-modulated radiotherapy. Patients were randomly allocated (1:1) to receive either nedaplatin (100 mg/m2) or cisplatin (100 mg/m2)-based chemotherapy every three weeks for three cycles, in addition to intensity-modulated radiotherapy.

The findings of this study are:

1. A total of 402 eligible individuals were included in the study (median [IQR] age, 45 [18-65] years; 302 [75.1% ] male).

2. Patients were randomly randomized to either nedaplatin- or cisplatin-based CCRT (n = 201 for each): 196 patients (97.5%) began nedaplatin-based CCRT, whereas 197 patients (98.0%) began cisplatin-based CCRT.

3. Intention-to-treat analysis revealed that the cisplatin group had a 5-year progression-free survival rate of 81.4% and the nedaplatin group had a rate of 79.8%, a difference of 1.6%.

4. There were no significant differences in 5-year overall survival, distant metastasis-free survival, or locoregional relapse-free survival rates between the cisplatin and nedaplatin groups.

5. The cisplatin group was more likely than the nedaplatin group to experience grade 3 and 4 auditory adverse effects.

6. These findings support the use of nedaplatin-based CCRT as an alternative to cisplatin-based CCRT in stage II to IVB nasopharyngeal cancer.

In conclusion, this long-term secondary investigation indicates that nedaplatin-based CCRT as doublet treatment for stage II to IVB NPC might be an option to cisplatin-based CCRT. The total late toxic impact rate was significantly reduced with nedaplatin-based CCRT. More research is needed to investigate the potential of nedaplatin in combination drug treatment in the induction or adjuvant phases. Our results have the potential to broaden the range of concurrent chemotherapy regimens available to individuals with NPC.

Reference:

Tang Q, Liu L, Qi B, et al. Effect of Concurrent Chemoradiotherapy With Nedaplatin vs Cisplatin on the Long-term Outcomes of Survival and Toxic Effects Among Patients With Stage II to IVB Nasopharyngeal Carcinoma: A 5-Year Follow-up Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021;4(12):e2138470. doi:10.1001/jamanetworkopen.2021.38470