Comparison of different induction chemotherapy regimens in pediatric and adolescent patients with locally advanced nasopharyngeal carcinoma.

Abstract

e18062 Background: Induction chemotherapy (IC) is a first-line treatment for locally advanced nasopharyngeal carcinoma (LA-NPC). However, data on the efficacy and safety of different IC regimens in pediatric patients remain scarce, as this group is often excluded from clinical trials. Methods: This retrospective study analyzed pediatric NPC patients (age ≤ 21 years) who received IC between 2006 and 2022. To balance confounding factors, inverse probability of treatment weighting (IPTW) was applied. Results: Among 493 included patients, the median follow-up was 69 months. Before adjustment, the taxane-plus-platinum (TP) group showed significantly shorter distant metastasis–free survival (DMFS) than the non-TP group, who received platinum plus 5-fluorouracil or capecitabine (TPF/C), platinum plus 5-fluorouracil (PF) or gemcitabine plus platinum (GP), (83.7% vs. 90.9%; P=0.03). Similar results were observed after IPTW adjustment. Conversely, the non-TP regimen was associated with a higher incidence of grade 3-4 toxicities (36.1% vs. 28.3%; P=0.004). Subgroup analysis revealed that TP-based IC was associated with worse DMFS in patients aged ≤14 years, those with EBV-DNA ≤4000 copies/mL, and those with N3 stage disease. Conclusions: For pediatric LA-NPC, a non-TP IC regimen was associated with superior PFS and DMFS compared to a TP regimen, despite a higher rate of severe toxicities. The TP regimen may be a suboptimal choice, particularly for patients under 14 or those with high-risk features.