Cancer Res Treat.  2024 Oct;56(4):1058-1067. 10.4143/crt.2023.1343.

Metronomic S-1 Adjuvant Chemotherapy Improves Survival in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

• Yu YF
• Wu P
• Zhuo R
• Wu SG

• KMID: 2560240
• DOI: http://doi.org/10.4143/crt.2023.1343

Abstract

Purpose
This study aimed to investigate the efficacy and safety of using metronomic S-1 adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma (LANPC).
Materials and Methods
We retrospectively collected data on patients diagnosed with LANPC between January 2016 and December 2021. All patients were treated with induction chemotherapy and concurrent chemoradiotherapy with or without metronomic chemotherapy (MC). Toxicities during MC were recorded. The chi-square test, Kaplan-Meier methods, propensity score matching (PSM), and Cox proportional hazards model were used for statistical analyses.
Results
A total of 474 patients were identified, including 64 (13.5%) and 410 (83.5%) patients with or without receiving MC, respectively. Patients who received metronomic S-1 had significantly better 3-year locoregional recurrence-free survival (LRFS) (100% vs. 90.9%, p=0.038), distant metastasis-free survival (DMFS) (98.5% vs. 84.1%, p=0.002), disease-free survival (DFS) (98.4% vs. 77.5%, p < 0.001), and overall survival (OS) (98.0% vs. 87.7%, p=0.008) compared to those without metronomic S-1. The multivariate prognostic analysis revealed that metronomic S-1 was identified as an independent prognostic factor associated with better DMFS (hazard ratio [HR], 0.074; p=0.010), DFS (HR, 0.103; p=0.002) and OS (HR, 0.127; p=0.042), but not in LRFS (p=0.071). Similar results were found using PSM. Common adverse events observed in the metronomic S-1 group included leukopenia, neutropenia, increased total bilirubin, anorexia, rash/desquamation, and hyperpigmentation. All patients with adverse events were grade 1-2.
Conclusion
It is worth conducting a randomized controlled trial to assess the effect of metronomic S-1 on survival outcomes and toxicities of LANPC.

Keyword

Nasopharyngeal carcinoma; Metronomic chemotherapy; S-1; Efficacy; Safety

Figure

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  Fig. 1. The locoregional recurrence-free survival (A), distant metastasis-free survival (B), disease-free survival (C), and overall survival (D) between those with and without metronomic S-1 treatment before propensity score matching.

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  Fig. 2. The locoregional recurrence-free survival (A), distant metastasis-free survival (B), disease-free survival (C), and overall survival (D) between those with and without metronomic S-1 treatment after propensity score matching.

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  Fig. 3. Retropharyngeal lymph node recurrence in a patient receiving metronomic S-1 treatment (A, retropharyngeal lymph node enlargement before induction chemotherapy; B, complete response to retropharyngeal lymph node after 3 months of concurrent chemoradiotherapy; C, retropharyngeal lymph node recurrence after 22 months of completing 1 year of S-1 treatment; D, complete response to retropharyngeal lymph node recurrence after reusing of metronomic S-1 treatment) (orange arrow).

Reference

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