NAB-paclitaxel and cisplatin versus gemcitabine and cisplatin as induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma: a retrospective, propensity score-matched analysis.

Background: The optimal induction chemotherapy (IC) regimen for locally advanced nasopharyngeal carcinoma (LA-NPC) remains uncertain. Objectives: The study aims to compare the efficacy and safety of nanoparticle albumin-bound paclitaxel plus cisplatin (NAB-TP) versus gemcitabine plus cisplatin (GP) as IC in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Design: A retrospective analysis. Methods: This study was conducted in LA-NPC patients treated at Sun Yat-sen University Cancer Center between 2012 and 2024. All patients received IC with either the GP or NAB-TP regimen followed by concurrent chemoradiotherapy (CCRT). Propensity score matching (PSM) was used to balance baseline characteristics between the GP and NAB-TP groups. Results: In total, 908 patients with LA-NPC (197 in the NAB-TP group) were enrolled. Before PSM, no statistically significant differences were observed between the NAB-TP and GP group in 5-year overall survival (OS; 98.67% vs 91.67%; p = 0.647), 5-year progression-free survival (PFS; 84.18% vs 66.22%; p = 0.587), 5-year locoregional relapse-free survival (LRFS; 88.13% vs 81.44%; p = 0.106), or 5-year distant metastasis-free survival (DMFS; 98.05% vs 89.88%; p = 0.106). After PSM, no differences were found in 5-year OS (98.60% vs 86.26%; p = 0.536), PFS (84.18% vs 66.22%; p = 0.587), LRFS (88.82% vs 76.14%; p = 0.757), or DMFS (97.95% vs 91.74%; p = 0.105). In the matched cohort, the NAB-TP group showed significantly lower incidences of anemia and thrombocytopenia than the GP group. Conclusion: IC with the NAB-TP combined with CCRT showed comparable survival efficacy for LA-NPC patients compared with the GP, with reduced acute toxicity.