1 Background Nasopharyngeal carcinoma(NPC)arises from the epithelial cells that cover and line the nasopharynx.While it is considered a rare cancer globally,it is commonly observed in South China and a few other ethni...1 Background Nasopharyngeal carcinoma(NPC)arises from the epithelial cells that cover and line the nasopharynx.While it is considered a rare cancer globally,it is commonly observed in South China and a few other ethnically distinct racial groups.Due to its propensity to spread early through the submucosal tissue and the highly infiltrative nature of this disease,NPC spreads easily through areas of lesser resistance within the pharyngobasilar fascia with a tendency for neural infiltration[1-3].展开更多
The Hong Kong Nasopharyngeal Carcinoma(NPC)Study Group 0501 trial(HK0501)is the first trial that directly compares induction(IC)versus adjuvant chemotherapy(AC)both given together with concurrent chemoradiation(CCRT)t...The Hong Kong Nasopharyngeal Carcinoma(NPC)Study Group 0501 trial(HK0501)is the first trial that directly compares induction(IC)versus adjuvant chemotherapy(AC)both given together with concurrent chemoradiation(CCRT)treatment,which long has been a contentious issue[1].Its most salient finding is that when adjusted for platinum doses and other significant factors,the timing of the chemotherapy sequence is not important.In the era where chemotherapy is administered at maximum tolerated doses(MTD),the induction strategy has the advantage because of better tolerability.On the other hand,with the realization that there may be more ways to skin a cat,adjuvant metronomic chemotherapy has gained traction at the 2021 American Society of Clinical Oncology(ASCO)meeting[2]and provides an alternative to the decades’old dogma of MTD.Metronomic chemotherapy works by exerting an anti-angiogenic effect[3-6]and also has immune effects like removing regulatory T cells(Tregs)[7]and myeloid-derived suppressor cells(MDSCs)from the tumour microenvironment[8]and causing dendritic cell maturation,which upregulates and primes the anti-tumor T cell immune response[9,10].Pediatricians are probably the first to successfully incorporate 2 years of maintenance metronomic chemotherapy in their childhood acute lymphoblastic leukaemia protocols[11]which now boast cure rates of over 90%[12].展开更多
文摘1 Background Nasopharyngeal carcinoma(NPC)arises from the epithelial cells that cover and line the nasopharynx.While it is considered a rare cancer globally,it is commonly observed in South China and a few other ethnically distinct racial groups.Due to its propensity to spread early through the submucosal tissue and the highly infiltrative nature of this disease,NPC spreads easily through areas of lesser resistance within the pharyngobasilar fascia with a tendency for neural infiltration[1-3].
文摘The Hong Kong Nasopharyngeal Carcinoma(NPC)Study Group 0501 trial(HK0501)is the first trial that directly compares induction(IC)versus adjuvant chemotherapy(AC)both given together with concurrent chemoradiation(CCRT)treatment,which long has been a contentious issue[1].Its most salient finding is that when adjusted for platinum doses and other significant factors,the timing of the chemotherapy sequence is not important.In the era where chemotherapy is administered at maximum tolerated doses(MTD),the induction strategy has the advantage because of better tolerability.On the other hand,with the realization that there may be more ways to skin a cat,adjuvant metronomic chemotherapy has gained traction at the 2021 American Society of Clinical Oncology(ASCO)meeting[2]and provides an alternative to the decades’old dogma of MTD.Metronomic chemotherapy works by exerting an anti-angiogenic effect[3-6]and also has immune effects like removing regulatory T cells(Tregs)[7]and myeloid-derived suppressor cells(MDSCs)from the tumour microenvironment[8]and causing dendritic cell maturation,which upregulates and primes the anti-tumor T cell immune response[9,10].Pediatricians are probably the first to successfully incorporate 2 years of maintenance metronomic chemotherapy in their childhood acute lymphoblastic leukaemia protocols[11]which now boast cure rates of over 90%[12].
