Induction Paclitaxel-Cisplatin-Capecitabine for Nasopharyngeal Carcinoma
In brief
Induction TPC chemo raises 5-year failure-free survival to 78% versus 63% with PF
In a randomized trial of 238 high-risk nasopharyngeal cancer patients, two cycles of paclitaxel-cisplatin-capecitabine before chemoradiation improved 5-year failure-free survival to 77.6% compared with 62.9% for cisplatin-fluorouracil, while overall survival and distant-metastasis rates were also higher. Toxicity was comparable, suggesting TPC as a viable induction option, though longer follow-up and broader validation are needed.
- Journal
- NEJM evidence (Q1)
- Published
- 25 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Wang-Zhong Li, Shu-Hui Lv, Shui-Qing He, Xing Lv, Lin Wang, Ya-Hui Yu, et al.
- PMID
- 42640170
- DOI
- 10.1056/EVIDoa2500278
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (top studies of the week, 30 August 2026): Induction paclitaxel‑cisplatin‑capecitabine improves 5‑yr FFS
Abstract
BACKGROUND: We previously reported higher failure-free survival (FFS) with induction paclitaxel, cisplatin, and capecitabine (TPC) compared with cisplatin and fluorouracil (PF) in high-risk locoregionally advanced nasopharyngeal carcinoma (LA-NPC). We now report 5-year FFS, with prespecified secondary outcomes. METHODS: In this multicenter, randomized trial, patients with high-risk LA-NPC (T4N0-2M0 or TanyN3M0) received two 21-day cycles of induction chemotherapy with TPC or PF, followed by concurrent chemoradiotherapy. The primary endpoint was FFS; secondary endpoints included distant metastasis-free, locoregional relapse-free, and overall survival (OS), tumor response, and safety. RESULTS: Among 238 patients (TPC, n=118; PF, n=120), with median follow-up of 89.1 months, 5-year FFS was 77.6% in the TPC group and 62.9% in the PF group (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.34-0.82). At 5 years, distant metastasis-free survival was 87.8% in the TPC group and 78.8% in the PF group (HR, 0.51; 95% CI, 0.28-0.95); locoregional relapse-free survival was 92.0% and 82.1%, respectively (HR, 0.43; 95% CI, 0.21-0.88); and OS was 89.6% and 82.2%, respectively (HR, 0.51; 95% CI, 0.27-0.95). Among patients with pretreatment Epstein-Barr virus (EBV) DNA <3000 copies/ml, 5-year OS was 92.3% in the TPC group and 84.4% in the PF group. Among those with higher EBV DNA levels, rates were 84.2% in TPC group and 81.1% in PF group. Grade 3 or 4 adverse events occurred in 68 patients (57.6%) receiving TPC and 79 patients (65.8%) receiving PF. Treatment adherence was similar in the two groups. CONCLUSIONS: Among patients with high-risk LA-NPC, TPC induction chemotherapy was associated with higher 5-year FFS than PF. (Funded by National Natural Science Foundation of China and State Key Laboratory of Respiratory Disease; ClinicalTrials.gov number, NCT02940925.).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.