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Research Paper|Volume 12, Issue 6|pp 4931—4944

Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients based on plasma Epstein–Barr virus DNA level after induction chemotherapy

Sai-Lan Liu1,2, Xue-Song Sun1,2, Li-Ting Liu1,2, Rui Sun1,2, Dong-Hua Luo1,2, Qiu-Yan Chen1,2, Huan-Xin Lin1,3, Li Yuan1,2, Lin-Quan Tang1,2, Ling Guo1,2, Hai-Qiang Mai1,2
  • 1Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, People's Republic of China
  • 2Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, People's Republic of China
  • 3Department of Radiotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, People's Republic of China
* Equal contribution and Co-first authors
# Co-senior authors
Received: November 26, 2019Accepted: March 3, 2020Published: March 27, 2020
https://doi.org/10.18632/aging.102920

Copyright © 2020 Liu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Purpose: This study aimed to elucidate the optimal cumulative cisplatin dose (CCD) for concurrent chemoradiotherapy (CCRT) according to the post-induction chemotherapy (IC) plasma Epstein–Barr virus (EBV) DNA level.

Results: EBV DNA was detected and undetected in 179 and 370 patients, respectively. Of the entire cohort, 73/549 (13.3%) patients received a total CCD ≥ 160 mg/m2 and 476/549 (86.7%) patients, <160 mg/m2. CCD enhancement was not associated with a survival benefit in patients with undetected EBV DNA after IC. However, among patients with post-IC detectable EBV DNA, higher 3-year PFS and locoregional relapse-free survival (LRFS) rates were observed in those who received a CCD ≥ 160 mg/m2. Multivariate analysis also showed CCD was an independent prognostic factor for PFS and LRFS in patients with post-IC detectable EBV DNA.

Conclusions: CCD enhancement was not associated with a survival benefit in patients with undetected EBV DNA after IC. However, among patients with post-IC detectable EBV DNA, those receiving ≥160 mg/m2 CCD showed significantly improved 3-year PFS and LRFS.

Methods: NPC patients (549) treated with IC and CCRT were included. Prognosis was assessed using a multivariate Cox proportional hazards model. Furthermore, grade 1–4 toxicities were compared between different CCD groups.