Head and Neck Cancer

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MO_28_2665 - Long-term prognostic effects of plasma EBV DNA load after induction chemotherapy in advanced nasopharyngeal carcinoma

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Long-term prognostic effects of plasma EBV DNA load after induction chemotherapy in advanced nasopharyngeal carcinoma
Y. C. Liu1, W. Y. Wang2, and J. C. Lin1; 1Taichung Veterans General Hospital, Taichung, Taiwan, 2Department of Nursing, Hung Kuang University, Taichung, Taiwan

Purpose/Objective(s): Induction chemotherapy (IndCT) has become an option of initial treatment for advanced nasopharyngeal carcinoma (NPC) patients. We hypothesized that plasma EBV DNA (pEBV DNA) status afterIndCT could predict long-term treatment outcome.

Materials/Methods: This retrospective study included 206 previously untreated, pathologically-proven NPC patients with stage II-IVB diseases and available pEBV DNA data after IndCT before radiotherapy (RT). All patients received a uniform protocol of ten weekly IndCT consisting of cisplatin 60 mg/m2 on day 1 and 5- fluorouracil 2500 mg/m2 + leucovorin 250 mg/m2 on day 8, repeated every 2 weeks for 5 cycles, followed by RT 70-74 Gy. After a median follow-up of 90 months, there were 71 recurrences and 85 deaths.

Results: Pretreatment pEBV DNA (median, 1550 copies/ml; interquantile range, 375-5688) was detectable in 95.1% (196/206) patients. Only 40.8% (84/206) patients had detectable pEBV DNA (> 0 copy/ml) after IndCT with very lower copy numbers (median, 18 copies/ml; interquantile range, 7-153, for these 84 patients). Patients with a higher N-classification (N3 vs. N0-2, P<0.0001) and overall stage (IV vs. II-III, P=0.0400) had a higher detectable pEBV DNA after IndCT. Forty-twor of 84 (50.0%) patients with detectable pEBV DNA (> 0 copy/ml) developed tumor relapse, whereas 23.8% (29/122) patients with undetectable pEBV DNA (= 0 copy/ml) had tumor relapse (P<0.0001). The patterns of failure revealed that patients with detectable post-IndCT pEBV DNA had more distant (39.3% vs. 17.2%, P=0.0004) and neck (7.1% vs. 1.6%, P=0.0650) failures but not local recurrence (11.9% vs. 9.8%, P=0.6366), compared with those of undetectable EBV DNA.The 5-year overall survival rates were 63.1% and 70.4% for patients with post-IndCT viral load > and = 0 copies/ml (P=0.0010). The corresponding figures of relapse-free survival rates were 54.4% and 78.4% (P<0.0001).

Conclusion: Post-IndCT pEBV DNA status can predict long-term outcome for NPC patients. More intensive treatment strategy for these high-risk patients with persistently detectable pEBV DNA after IndCT should be studied further.

Author Disclosure: Y. Liu: None. W. Wang: None.

Yi Chun Liu, MD

Biography:
Yi-Chun Liu, M.D.
Department of Radiation Oncology, Taichung Veterans General Hospital
E-mail:b9202080@gmail.com
Publications:
1. Liu YC, Liu YC, Lin JC. Preliminary Results of Induction Bio-Chemotherapy followed by Radiotherapy for Advanced Nasopharyngeal Carcinoma. Therapeut Radiol Oncol 2018; 25(2): 65-74
2. Lin PJ, Twu CW, Liu YC, Lin TY, Wang WY, Lin JC. Comparison the clinical outcomes with altered versus conventional fractionated radiotherapy plus concurrent chemotherapy for advanced nasopharyngeal carcinoma. Head Neck. 2018, 40(6):1156-1163
3. Liu YC, Wang WY, Twu CW, Jiang RS, Liang KL, Lin PJ, Lin JW, Lin JC. Comparison Long-term Outcome of Definitive Radiotherapy plus Different Chemotherapy Schedules in Patients with Advanced Nasopharyngeal Carcinoma. Sci Rep. 2018, 11;8(1):470.
4. Lin JW, Liu YC, Hsieh HY, et al., Comparison Of Acute Toxicities And Treatment Tolerance Between Tri-Weekly High-Dose And Weekly Low-Dose Cisplatin During Concurrent Chemoradiotherap For Head And Neck Cancer Patients. Therapeut Radiol Oncol 2017; 24(4): 261-268
5. Liu YC, Wang WY, Twu CW, Jiang RS, Liang KL, Wu CT, Lin PJ, Huang JW, Hsieh HY, Lin JC. Prognostic impact of adjuvant chemotherapy in high-risk nasopharyngeal carcinoma patients. Oral Oncol 2017;64:15-21.
6. Wang WY, Lin TY, Twu CW, Tsou HH, Lin PJ, Liu YC, Huang JW, Hsieh HY, Lin JC. Long-term clinical outcome in nasopharyngeal carcinoma patients with post-radiation persistently detectable plasma EBV DNA. Oncotarget 2016; 7(27):42608-42616.
7. Twu CW, Wang WY, Chen CC, Liang KL, Jiang RS, Wu CT, Shih YT, Lin PJ, Liu YC, Lin JC. Metronomic adjuvant chemotherapy improves treatment outcome in nasopharyngeal carcinoma patients with postradiation persistently detectable plasma Epstein-Barr virus deoxyribonucleic acid. Int J Radiat Oncol Biol Phys 2014; 89(1):21-9.
8. Liu YC, Lin PJ, Lin JC. Second primary malignancies after definitive radiotherapy for nasopharyngeal carcinoma. Therapeut Radiol Oncol 2014; 21:257-265.

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