Triplet combination of gemcitabine, paclitaxel, and carboplatin followed by maintenance 5‐fluorouracil and folinic acid in patients with metastatic nasopharyngeal carcinoma

BACKGROUND. Nasopharyngeal carcinoma (NPC) is a disease that is highly responsive to various chemotherapeutic agents. In the metastatic setting, 2‐drug combination chemotherapy generally provides a response rate of 55% to 75%, and median survival of 10 to 12 months. The objective of the current study was to assess the efficacy of a 3‐drug combination followed by maintenance treatment in patients with metastatic NPC. METHODS. Patients with metastatic NPC were treated with a combination of gemcitabine at a dose of 1000 mg/m 2 , paclitaxel at a dose of 70 mg/m 2 , and carboplatin at an area under the concentration‐time‐curve (AUC) of 2.5 on Days 1 and 8 every 21 days. Patients who achieved partial or complete response continued to receive weekly 5‐fluorouracil at a dose of 450 mg/m 2 and leucovorin at a dose of 30 mg/m 2 for 48 weeks. RESULTS. Twenty‐eight patients were recruited. Twenty‐two (79%) patients had ≥2 sites of disease. Toxicities were mainly from bone marrow suppression, with 79% grade 3/4 neutropenia, 32% grade 3/4 anemia, and 29% grade 3/4 thrombocytopenia (according to the National Cancer Institute Common Toxicity Criteria). The overall response rate to the 3‐drug regimen was 86%, with a complete response rate of 11%. The median duration of response was 8 months and the median overall survival was 22 months. CONCLUSIONS. This regimen of a 3‐drug combination followed by maintenance is feasible and has demonstrated an encouraging response rate and overall survival. Cancer 2008. © 2008 American Cancer Society.