Adjuvant chemotherapy in nasopharyngeal carcinoma
Mené en Chine entre 2017 et 2020 sur 240 patients atteints d'un carcinome du rhinopharynx de stade N2-3 (durée médiane de suivi : 40 mois ; âge médian : 44 ans ; 27 % de femmes), cet essai randomisé multicentrique de phase III évalue l'efficacité, du point de vue de la survie sans progression à 3 ans, et la toxicité d'une chimiothérapie à base de cisplatine–gemcitabine et d'une autre associant cisplatine et fluorouracile, dispensées après une chimioradiothérapie
Résumé en anglais
The value of adjuvant chemotherapy after definitive radiotherapy in locoregionally advanced nasopharyngeal carcinoma has been debated since the landmark publication of the Intergroup-0099 trial. The differing views occur for two reasons: (1) early chemoradiotherapy trials in the 2000s investigated various platinum-based regimens of concurrent chemoradiotherapy alone or in combination with adjuvant chemotherapy, with both strategies showing survival benefits over radiotherapy alone; and (2) it was generally observed that platinum doublet adjuvant chemotherapy after concurrent chemoradiotherapy was poorly tolerated. The resistance towards recommending adjuvant chemotherapy to patients in the clinic was compounded after a phase 3 trial in China showed that adjuvant cisplatin–fluorouracil chemotherapy did not significantly improve failurefree survival after concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma compared with concurrent chemoradiotherapy alone.
