J Cancer 2018; 9(9):1642-1651. doi:10.7150/jca.23994

Research Paper

Effectiveness of Cetuximab in Combination with Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma: A 1:2 Propensity Score-matched Analysis

Li-Rong Wu*, Huan-feng Zhu*, Jianhua Xu*, Xue-song Jiang, Li Yin, Ning Jiang, Dan Zong, Fei-jiang Wang, Sheng-fu Huang, Xiu-hua Bian, Jian-feng Wu, Dan Song, Wen-jie Guo, Ju-Ying Liu, Xia He

Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, 42# Baiziting Road, Xuanwu District, Nanjing 210009, China
* These authors contributed equally to this work.

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Citation:
Wu LR, Zhu Hf, Xu J, Jiang Xs, Yin L, Jiang N, Zong D, Wang Fj, Huang Sf, Bian Xh, Wu Jf, Song D, Guo Wj, Liu JY, He X. Effectiveness of Cetuximab in Combination with Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma: A 1:2 Propensity Score-matched Analysis. J Cancer 2018; 9(9):1642-1651. doi:10.7150/jca.23994. Available from http://www.jcancer.org/v09p1642.htm

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Abstract

Background: This study aimed to compare concurrent chemoradiotherapy (CCRT) plus cetuximab (C) with CCRT alone in locoregionally advanced nasopharyngeal carcinoma(NPC).

Methods: A total of 682 locoregionally advanced NPC patients who had undergone chemoradiotherapy with or without cetuximab were included. Propensity score-matching method was used to match patients. Progression-free survival (PFS), overall survival (OS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared between the two treatment arms.

Results: After matching, 225 patients were identified for the analysis. Compared to CCRT, CCRT plus C was associated with significantly improved 3-year PFS (83.7% vs 71.9%, P = 0.036), LRFS (98.6% vs 90.2%, P = 0.034) but not OS (91.4% vs 85.4%, P = 0.117). Among patients with T4 and/or N3 category, CCRT plus C significantly prolonged 3-year PFS (81.0% vs 61.4%, P = 0.022) and increased 3-year OS (88.0% vs 77.9%, P = 0.086). No significant differences were observed between CCRT plus C and CCRT alone groups with regard to 3-year PFS, OS, LRFS and DMFS rates in stage III patients. Acute oral and oropharyngeal mucositis during radiotherapy were more common in the CCRT plus C than that in CCRT, but late toxicities were comparable.

Conclusions: This study reveals that patients with locoregionally advanced NPC could benefit from the addition of cetuximab to CCRT, and this therapeutic gain mainly originated from T4 and/or N3 subgroup although suffering more acute moderate to severe toxicities.