This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chan, A. T.C. Articles by Zee, B. Search for Related Content PubMed PubMed Citation Articles by Chan, A. T.C. Articles by Zee, B. Social Bookmarking                            What's this?

Phase II Study of Neoadjuvant Carboplatin and Paclitaxel Followed by Radiotherapy and Concurrent Cisplatin in Patients With Locoregionally Advanced Nasopharyngeal Carcinoma: Therapeutic Monitoring With Plasma Epstein-Barr Virus DNA

From the Departments of Clinical Oncology, Chemical Pathology, and Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China

Address reprint requests to Anthony T.C. Chan, MD, FRCP, Department of Clinical Oncology at the Sir Y.K. Pao Center for Cancer, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region, China; e-mail: anthonytcchan{at}cuhk.edu.hk

PURPOSE: To assess the efficacy of neoadjuvant paclitaxel and carboplatin (TC) followed by concurrent cisplatin and radiotherapy (RT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and to monitor treatment response with plasma Epstein-Barr virus (EBV) DNA.

PATIENTS AND METHODS: Thirty-one patients with International Union Against Cancer stages III and IV undifferentiated NPC had two cycles of paclitaxel (70 mg/m² on days 1, 8, and 15) and carboplatin (area under the curve 6 mg/mL/min on day 1) on a 3-weekly cycle, followed by 6 to 8 weeks of cisplatin (40 mg/m² weekly) and RT at 66 Gy in 2-Gy fractions. Plasma EBV DNA was measured serially using the real-time quantitative polymerase chain reaction method.

RESULTS: All patients completed planned treatment. Response to neoadjuvant TC was as follows: 12 patients (39%) achieved partial response (PR) and 18 achieved (58%) complete response (CR) in regional nodes; five patients (16%) achieved PR and no patients achieved CR in nasopharynx. At 6 weeks after RT, one patient (3%) achieved PR and 30 patients (97%) achieved CR in regional nodes, and 31 patients (100%) achieved CR in nasopharynx; 29 patients (93%) had EBV DNA level of less than 500 copies/mL. Neoadjuvant TC was well tolerated, and the most common acute toxicity of cisplatin plus RT was grade 3 mucositis (55%). At median follow-up of 33.7 months (range, 7 to 39.3 months), six distant and three locoregional failures occurred. Plasma EBV DNA level increased significantly in eight of nine patients who experienced treatment failure but did not increase in those who did not. The 2-year overall and progression-free survival rates were 91.8% and 78.5%, respectively.

CONCLUSION: This strategy was feasible and resulted in excellent local tumor control. Serial plasma EBV DNA provides a noninvasive method of monitoring response in NPC.

Supported in part by a central allocation fund of the Research Grants Council of Hong Kong, the Institute of Molecular Oncology at the Chinese University of Hong Kong, and a research grant from Bristol-Myers Squibb.

Presented in part at the 38th Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 18-21, 2002.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				W.-S. Hsieh, R. Soo, B.-K. Peh, T. Loh, D. Dong, D. Soh, L.-S. Wong, S. Green, J. Chiao, C.-Y. Cui, et al. Pharmacodynamic Effects of Seliciclib, an Orally Administered Cell Cycle Modulator, in Undifferentiated Nasopharyngeal Cancer Clin. Cancer Res., February 15, 2009; 15(4): 1435 - 1442. [Abstract] [Full Text] [PDF]

				E. P. Hui, B. B. Ma, S. F. Leung, A. D. King, F. Mo, M. K. Kam, B. K. Yu, S. K. Chiu, W. H. Kwan, R. Ho, et al. Randomized Phase II Trial of Concurrent Cisplatin-Radiotherapy With or Without Neoadjuvant Docetaxel and Cisplatin in Advanced Nasopharyngeal Carcinoma J. Clin. Oncol., January 10, 2009; 27(2): 242 - 249. [Abstract] [Full Text] [PDF]

				N. Choong and E. Vokes Expanding Role of the Medical Oncologist in the Management of Head and Neck Cancer CA Cancer J Clin, January 1, 2008; 58(1): 32 - 53. [Abstract] [Full Text] [PDF]

				A. S. C. Wong, R. A. Soo, J. J. Lu, K. S. Loh, K. S. Tan, W. S. Hsieh, T. P. Shakespeare, E. T. Chua, H. L. Lim, and B. C. Goh Paclitaxel, 5-fluorouracil and hydroxyurea concurrent with radiation in locally advanced nasopharyngeal carcinoma Ann. Onc., July 1, 2006; 17(7): 1152 - 1157. [Abstract] [Full Text] [PDF]

				J S Kalpoe, P B Douwes Dekker, J H J M van Krieken, R J Baatenburg de Jong, and A C M Kroes Role of Epstein-Barr virus DNA measurement in plasma in the clinical management of nasopharyngeal carcinoma in a low risk area J. Clin. Pathol., May 1, 2006; 59(5): 537 - 541. [Abstract] [Full Text] [PDF]

				Q.-T. Le, C. D. Jones, T.-K. Yau, H. A. Shirazi, P. H. Wong, E. N. Thomas, B. K. Patterson, A. W.M. Lee, and J. L. Zehnder A Comparison Study of Different PCR Assays in Measuring Circulating Plasma Epstein-Barr Virus DNA Levels in Patients with Nasopharyngeal Carcinoma Clin. Cancer Res., August 15, 2005; 11(16): 5700 - 5707. [Abstract] [Full Text] [PDF]

				A. T. C. Chan, S. F. Leung, R. K. C. Ngan, P. M. L. Teo, W. H. Lau, W. H. Kwan, E. P. Hui, H. Y. Yiu, W. Yeo, F. Y. Cheung, et al. Overall Survival After Concurrent Cisplatin-Radiotherapy Compared With Radiotherapy Alone in Locoregionally Advanced Nasopharyngeal Carcinoma J Natl Cancer Inst, April 6, 2005; 97(7): 536 - 539. [Abstract] [Full Text] [PDF]