The safety and efficacy of gemcitabine and cisplatin (GP)-based induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a meta-analysis

Objective To assess the safety and efficacy of gemcitabine and cisplatin (GP)-based induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Methods We systematically searched the PubMed, Web of Science, Embase, and Cochrane Library databases. The endpoints included overall survival (OS), progression-free survival (PFS), distant failure-free survival (DMFS), locoregional failure-free survival (LRFFS) and treatment-related adverse events (AEs). Results A total of seven studies were included in this meta-analysis. When GP-based IC was compared with double-drug-based or triple-drug-based IC, there were no significant differences in OS (HR 0.64, P = 0.08), PFS (HR 0.71, P = 0.09), DMFS (HR 0.87, P = 0.49) or LRFFS (HR 0.88, P = 0.66). Furthermore, subgroup analysis revealed that GP IC led to an improvement in OS compared with triple-drug-based IC (P < 0.0001). Regarding safety, compared to triple-drug-based IC, GP-based IC was related to a decreased risk of leucopenia (P = 0.007) and neutropenia (P = 0.02) but was associated with an increased risk of thrombocytopenia (P = 0.01). Compared to double-drug-based IC, the prevalence of grade 3 or above thrombocytopenia was higher in the GP group (P = 0.007). No significant difference in the incidence of other AEs was observed. Conclusion Based on efficacy and safety, our meta-analysis demonstrated that, compared to double-drug-based or triple-drug-based IC, IC with a GP regimen does not appear to improve OS, PFS, DMFS or LRFFS and mainly led to an increased risk of grade3/4 thrombocytopenia. Notably, our subgroup analysis data show that GP-based IC may bring improved trends in OS as compared to triple-drug-based IC. For the optimal IC regimen has not been established, which IC regimen will benefit most LA-NPC patients should be further explored.