ASCO Breakthrough 2024: Radiation Alone Works as Well as Chemoradiation for Low-Risk Nasopharyngeal Cancer

ASCO Breakthrough 2024 features keynotes from global leaders, multidisciplinary educational and case-based sessions, rapid oral abstract presentations, and poster sessions with expert-led walks. Hosted in Japan from August 8-10, the event highlights the latest advancements in oncology research. Updated results from a phase 3 clinical trial in China show that radiation therapy alone is as effective as concurrent chemoradiation for treating low-risk nasopharyngeal cancer. This method helps patients avoid severe side effects associated with chemoradiation, such as hearing loss and significant weight loss.

Radiation Therapy Alone vs. Chemoradiation for Low-Risk Nasopharyngeal Cancer

Nasopharyngeal cancer is rare outside of China but is more common within the country, affecting 25 to 30 men and 15 to 20 women per 100,000 annually. About 20% to 40% of these cases are classified as low-risk, defined as stage II or T3N0 disease with limited lymph node involvement and low Epstein-Barr virus (EBV) DNA levels. 

Updated results from a multicenter, open-label, non-inferiority, randomized Phase III trial involving 341 patients with low-risk nasopharyngeal cancer, participants were randomly assigned to receive either radiation therapy alone or the standard chemoradiation treatment. After a median follow-up of 70.1 months, the 5-year overall survival rate was 95.2% for the radiation therapy group compared to 98.2% for the chemoradiation group. Additionally, the failure-free survival rates were 86.2% and 88.4%, respectively. These differences were not statistically significant, indicating that both treatments provided similar outcomes.

Lead study author Rui Guo, MD, from Sun Yat-sen University Cancer Center, noted, “In the era of intensity-modulated radiation therapy (IMRT) for low-risk nasopharyngeal cancer, IMRT alone is effective and safe. Patients in the IMRT-alone group had a significantly lower incidence of reported grade 3 or 4 adverse events compared to those who received concurrent chemoradiation. Additionally, patients in the IMRT-alone group reported significantly better quality-of-life scores during treatment.”

Chemoradiation Causes More Hearing Problems and Severe Side Effects

Patients receiving chemoradiation experienced more hearing problems and severe side effects compared to those receiving only radiation therapy. Specifically, about 31% of patients in the chemoradiation group had hearing impairment, while about 23% of patients in the radiation therapy group did. Additionally, serious side effects, such as mouth sores, nausea, vomiting, and appetite loss, occurred more frequently in the chemoradiation group.

During treatment, 46% of patients in the chemoradiation group experienced these severe side effects, whereas only 17% of those in the radiation therapy group did. Consequently, radiation therapy alone led to fewer adverse effects, highlighting a significant difference in tolerability between the two treatment approaches.

Glenn J. Hanna, MD, Director of the Center for Cancer Therapeutic Innovation and Center for Head and Neck Oncology at the Dana-Farber Cancer Institute, commented, “It is important to see comparable 5-year overall survival among lower-risk patients with nasopharyngeal cancer treated with radiation therapy alone. This data suggests that chemoradiation may yield similar outcomes but add unnecessary toxicity and speaks to the broader theme of tailoring treatment to each patient.”

New Treatment Developments and Market Insights for Nasopharyngeal Carcinoma

Recent reports indicate that the global nasopharyngeal cancer market will grow from USD 873.92 million to USD 1,136.28 million over the next decade. This growth stems from rising nasopharyngeal cancer cases and increased public awareness about diagnosis and treatment. Additionally, the growing popularity of proton therapy, which precisely targets tumors while sparing healthy tissues, is expected to drive further market expansion.

In drug developments, the Food and Drug Administration (FDA) has approved toripalimab (Loqtorzi), the first immunotherapy drug for nasopharyngeal carcinoma (NPC). The approval followed results from two clinical trials conducted in Asia, where NPC is more common. The FDA has approved toripalimab for use as an initial treatment for recurrent or metastatic NPC and for use alone when NPC worsens despite standard chemotherapy. Shanghai Junshi Biosciences, the drug’s developer, sponsored both trials.

Author

Bernice Lottering