Annals of Oncology Advance Access originally published online on May 9, 2006
Annals of Oncology 2006 17(7):1152-1157; doi:10.1093/annonc/mdl090
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© 2006 European Society for Medical Oncology
Paclitaxel, 5-fluorouracil and hydroxyurea concurrent with radiation in locally advanced nasopharyngeal carcinoma
1 Department of Hematology-Oncology, National University Hospital, 2 Department of Radiation Oncology, National University Hospital, 3 Department of Otolaryngology-Head and Neck Surgery, National University Hospital, 4 Division of Biomedical Sciences, Johns Hopkins in Singapore; 5 Department of Therapeutic Radiology, National Cancer Centre, Singapore
* Correspondence to: Dr A.S.C. Wong, Department of Hematology-Oncology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. Tel: +(65) 6772–2527; Fax: +(65) 6777–5545; E-mail: Alvin_SC_WONG{at}nuh.com.sg
Background: Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced nasopharyngeal carcinoma (NPC). We conducted a phase II trial using paclitaxel, 5-fluorouracil and hydroxyurea concurrent with radiation (TFHX).
Patients and methods: Fifty-nine patients with locally advanced NPC were treated with CRT consisting of 4-day continuous infusions of paclitaxel (20 mg/m2/d) and 5-fluorouracil (600 mg/m2/d), and oral hydroxyurea 500 mg bid for nine doses, every 3 weeks concurrent with radiotherapy (RT). RT consisted of once daily 200cGy fractions 5 times per week to a total of 7000cGy.
Results: Complete response was seen in 86% and 71% of patients at 4 and 12 months after CRT. The median follow-up was 34 months. Twenty-three patients experienced relapse. Sixteen deaths occurred: 13 from progressive disease. Three-year overall survival and progression-free survival were 72% and 54% respectively, with locoregional and distant control rates of 83% and 64% at 3 years respectively. Grade 3 to 4 acute toxicities included oropharyngeal mucositis in 81% of patients treated, dermatitis in 63%, weight loss in 32%, and neutropenia in 22%. Neutropenic fever was seen in 14%. There were no treatment-related deaths from acute toxicity.
Conclusions: TFHX is shown to be feasible in NPC. Non-cross resistant induction chemotherapy should be further studied with this regimen.
Key words: 5-fluorouracil, hydroxyurea, nasopharyngeal carcinoma, paclitaxel, radiotherapy
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