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Effects of oral maintenance chemotherapy and predictive value of circulating EBV DNA in metastatic nasopharyngeal carcinoma

Zhou  Han  Lu  Tianzhu  Guo  Qiaojuan  Chen  Yan  Chen  Mengwei  Chen  Yansong  Lin  Yingying  Chen  Chuanben  Ma  Liqin  Xu  Yun  Lin  Shaojun  Pan  Jianji  
【摘要】:Oral maintenance chemotherapy can effectively prolong overall survival(OS) in many types of metastatic cancer,but its role in metastatic nasopharyngeal carcinoma(mNPC) is unclear.In this study,the efficacy of oral maintenance chemotherapy in mNPC and the effectiveness of circulating tumor EBV-DNA for screening patients were evaluated.Between June 2016 and December 2017,141 patients with mNPC who received platinum-based systemic chemotherapy were included(median follow-up time,21 months).Patients were classified into two groups according to the administration of oral maintenance chemotherapy.Plasma samples were collected before,during,and after treatment for the measurement of circulating EBV DNA.The 2-year OS was higher for patients who received maintenance chemotherapy than for patients without maintenance chemotherapy(78.9% vs.62.7%,p = 0.016).Patients with undetectable post-treatment EBV-DNA after 4–6 cycles of systemic chemotherapy(n = 73) had a higher 2-year OS than that of patients with detectable EBV-DNA(n = 68)(82.16% vs.51.45%,p = 0.001).For patients with undetectable post-treatment EBV-DNA,OS was better for those with maintenance chemotherapy than for those without(86.7% vs.73%,p = 0.027).For patients with detectable post-treatment EBV-DNA,maintenance chemotherapy did not improve outcomes(49.5% vs.55.4%,p = 0.824).The most common acute events were hematological toxicity,and all were tolerable and curable.Oral maintenance chemotherapy with S1 or capecitabine can improve OS in mNPC.Post-treatment EBV-DNA was an independent prognostic factor for m NPC.For patients with detectable EBV-DNA after systematic chemotherapy,maintenance chemotherapy was not sufficient.

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