cohort·oncology, radiation oncology, nutrition, head and neck oncology·PMC10067484
Effects of induction chemotherapy on nutrition status in locally advanced nasopharyngeal carcinoma: a multicentre prospective study
Journal of Cachexia, Sarcopenia and Muscle · 23 authors, 17 centres
AI SUMMARY
FIDELITY 100%
POPULATIONPatients with newly diagnosed, histologically confirmed non-keratinizing nasopharyngeal carcinoma, stage III–IVb (AJCC/UICC 7th edition), aged 18–65 years, KPS ≥80, from 10 academic institutions in China (n=171).
INTERVENTIONInduction chemotherapy (two cycles of 3-weekly docetaxel 75 mg/m² and cisplatin 75 mg/m²) followed by concurrent chemoradiotherapy (two to three cycles of 3-weekly cisplatin 100 mg/m² with intensity-modulated radiotherapy).
COMPARISONPatients with cumulative weight loss ≥5.0% by end of treatment vs those with weight loss <5.0%.
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This prospective multicentre study of 171 patients with locally advanced nasopharyngeal carcinoma (LA-NPC) found that 71.9% experienced ≥5% weight loss by the end of induction chemotherapy plus concurrent chemoradiotherapy, with weight loss peaking during the chemoradiotherapy phase. Weight loss ≥5% was significantly associated with higher malnutrition risk (NRS2002 ≥3: 87.7% vs 58.7%, p<0.001), greater need for nutritional intervention (PG-SGA ≥9: 82.0% vs 66.7%, p=0.038), and worse quality of life (difference of −8.3 points, p=0.019). These findings support routine nutritional monitoring and intervention during the later phase of treatment for LA-NPC patients.
Full summary
3,555 CHARS
**Background:** Induction chemotherapy (IC) added to concurrent chemoradiotherapy (CCRT) is standard of care for locoregionally advanced nasopharyngeal carcinoma (LA-NPC), but this intensive regimen increases acute toxicities that may negatively impact nutritional status. Weight loss (WL) is the most common indicator of malnutrition in head and neck cancer, with about half of patients affected. Previous studies in NPC were largely retrospective or small series, and no prospective data existed on the timing and impact of malnutrition during IC+CCRT.
**Methods:** This prospective observational trial enrolled 186 patients from 10 Chinese academic institutions (June 2015–November 2016); 171 were evaluable. Eligible patients had newly diagnosed, histologically confirmed non-keratinizing NPC, stage III–IVb (7th AJCC/UICC), age 18–65, KPS ≥80. IC consisted of two cycles of 3-weekly docetaxel 75 mg/m² and cisplatin 75 mg/m². CCRT commenced 3–4 weeks after IC with cisplatin 100 mg/m² on days 1, 22 and/or 43, plus radical IMRT (70–72 Gy to PTVp). Nutritional status and QoL were assessed at five timepoints: pre-IC, post-cycle 1 IC, post-cycle 2 IC (pre-CCRT), week 4 of CCRT (W4-CCRT), and week 7 of CCRT (W7-CCRT). The primary endpoint was cumulative proportion of ≥5.0% weight loss (WL₅.₀) by W7-CCRT. Secondary endpoints included BMI, NRS2002 and PG-SGA scores, QoL (EORTC QLQ-C30 v3.0), hypoalbuminaemia, treatment compliance, acute/late toxicities, and survival. Sample size of 169 was calculated (80% power, α=0.05) assuming 69% WL₅.₀ incidence; 186 were enrolled accounting for 10% dropout.
**Key Results:** Median follow-up was 67.4 months (IQR: 64.1–71.2). Treatment compliance was high: 97.7% completed two IC cycles, 87.7% completed ≥2 concurrent chemotherapy cycles, and all but one patient completed IMRT. Median body weight decreased from 63.0 kg (IQR: 56.0–70.0) pre-treatment to 58.0 kg (IQR: 52.0–65.0) at W7-CCRT (p<0.001). WL was minimal during IC (median 0.0%), increased sharply at W4-CCRT (median 4.0% [IQR: 0.0–7.0%]), and peaked at W7-CCRT (median 8.5% [IQR: 4.1–11.7%]). By end of treatment, 71.9% (123/171) had WL₅.₀. Patients with WL₅.₀ had significantly higher malnutrition risk (NRS2002 ≥3: 87.7% vs 58.7%, p<0.001) and greater need for nutritional intervention (PG-SGA ≥9: 82.0% vs 66.7%, p=0.038). Median %WL at W7-CCRT was higher in patients with ≥G2 mucositis (9.0% vs 6.6%, p=0.025) and xerostomia (9.1% vs 6.3%, p=0.003). Mean QoL declined from 73.5±17.5 points pre-treatment to 48.5±19.6 at W7-CCRT (adjusted mean change −26.0 points [95% CI: −29.1, −22.8], p<0.001). Patients with WL₅.₀ had significantly lower QoL at W7-CCRT (difference −8.3 points [95% CI: −15.1, −1.4], p=0.019). No significant association was found between WL₅.₀ and survival (HR 1.06 [95% CI: 0.51–2.19], p=0.874). The 5-year DFS, DMFS, LRRFS, and OS were 79.3%, 83.5%, 85.7%, and 91.1%, respectively.
**Clinical Implications:** This study provides prospective evidence that WL₅.₀ occurs in nearly three-quarters of LA-NPC patients undergoing IC+CCRT, peaking during the CCRT phase, and is strongly associated with malnutrition risk, need for nutritional intervention, and QoL deterioration. Although WL₅.₀ was not associated with survival, its impact on patient-reported outcomes supports routine nutritional monitoring and timely intervention during the later phase of treatment. The authors have designed a follow-up phase 3 RCT (NCT04436965) to test whether active nutritional intervention can mitigate malnutrition and improve QoL.
PICO
PPOPULATION
Patients with newly diagnosed, histologically confirmed non-keratinizing nasopharyngeal carcinoma, stage III–IVb (AJCC/UICC 7th edition), aged 18–65 years, KPS ≥80, from 10 academic institutions in China (n=171).
IINTERVENTION
Induction chemotherapy (two cycles of 3-weekly docetaxel 75 mg/m² and cisplatin 75 mg/m²) followed by concurrent chemoradiotherapy (two to three cycles of 3-weekly cisplatin 100 mg/m² with intensity-modulated radiotherapy).
OOUTCOME
Primary: cumulative proportion of ≥5.0% weight loss by end of CCRT. Secondary: BMI, NRS2002 and PG-SGA scores, QoL (EORTC QLQ-C30), hypoalbuminaemia, treatment compliance, acute/late toxicities, survival (DFS, DMFS, LRRFS, OS).