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Intensity modulated radiation therapy combined with cetuximab and cisplatin in treatment of advanced nasopharyngeal carcinoma
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Abstract:
Abstract Objective: Epidermal growth factor receptor（EGFR）is closesly related to nasopharyngeal carcinoma (NPC). Cetuximab is a monoclonal antibody that specifically blocks the EGFR. We aimed to explore the efficacy and toxicity of intensity modulated radiation therapy (IMRT) combined with cetuximab and cisplatin in the treatment of patients with NPC. Methods: From July 2007 to December 2007, 8 patients, including 7 with primary NPC patients and one with reoccurred NPC were included in this study; all patients were at stage Ⅲ or Ⅳ. Treatment included IMRT, cisplatin and cetuximab (400 mg/m2 one week prior to radiotherapy, followed by 250 mg/m2 once a week during radiotherapy). Results: All eight patients completed the planned IMRT. The median treatment cycle of cetuximab was 6 (ranging 4 to 8 cycles). Three patients received no chemotherapy due to hepatic dysfunction; 3 were treated with 4-7 cycles of cisplatin (30 mg/ m2, once a week); one was treated with two cycles of cisplatin (100 mg/m2); and another was treated with one cycle of cisplatin (100 mg/m2). All eight patients were presented with acnelike rash. The acute side effects were mucositis and neutropenia. Mucositis occurred in all the 8 patients; neutropenia occurred in 3 patients. After combined therapy, all 8 patients achieved complete remission (CR). During a followup of 4-10 months, one patient was diagnosed as having leb metastasis. Conclusion: IMRT in combination with cetuximab and chemotherapy in treatment of acute mucositis in patients with advanced nasopharyngeal carcinoma is too much for the patients; two of patients in the present group are intolerable. We suggest dose decrease of cetuximab. The short term efficacy is encouraging, and the longterm outcomes need to be further investigated.
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