Comparing three induction regimens for nasopharyngeal carcinoma: a propensity score-matched analysis.

Background: Induction chemotherapy (IC) regimens such as gemcitabine plus cisplatin (GP), docetaxel plus cisplatin plus fluorouracil (TPF), and paclitaxel plus cisplatin (TP) are optional clinical options for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Objectives: This study aims to evaluate the efficacy and toxicity profiles of the GP, TPF, and TP induction regimens in LA-NPC. Design: This was a retrospective study. Methods: This multicenter retrospective study enrolled 722 patients with stage III-IVA LA-NPC who received GP, TPF, or TP IC. Propensity score matching (PSM) was performed before comparing survival outcomes and acute grades 3-4 toxicities among the three groups. Survival outcomes included the overall survival (OS), failure-free survival (FFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). Results: The original cohort comprised 722 patients (247 in the GP group, 240 in the TPF group, and 235 in the TP group). After PSM analysis, the GP group showed a better 3-year OS rate than the TP group (p = 0.019), while the 3-year OS rate revealed no difference between the GP group and TPF group and between the TPF group and TP group. There were no significant differences in the 3-year FFS, 3-year LRFS, and 3-year DMFS rates between and within the three groups. During the induction period, the toxicity of the three regimens was generally acceptable and manageable. Conclusion: The GP induction regimen demonstrated superior efficacy in terms of OS, with its favorable safety profile. Compared with the TPF and TP regimens, the GP induction regimen represents a more clinically advantageous treatment option for LA-NPC.