Paclitaxel and Cisplatin Combination Improves Outcomes in Locoregionally Advanced Nasopharyngeal CarcinomaTrial shows TPC chemotherapy improves survival for nasopharyngeal carcinoma

NEJM Evidence Published August 27, 2026 Study authors: Li Wang-Zhong, Lv Shu-Hui, He Shui-Qing, Lv Xing, Wang Lin, Yu Ya-Hui, Xia Wei-Xiong, Ye Yan-Fang, H… PubMed ↗ NCT02940925 ↗ DOI ↗ Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

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Key Takeaway

TPC induction chemotherapy significantly improves failure-free survival and overall survival in high-risk nasopharyngeal carcinoma.

This multicenter randomized trial evaluated the efficacy of induction chemotherapy regimens in 238 patients with high-risk locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Patients were assigned to receive either paclitaxel, cisplatin, and capecitabine (TPC) or cisplatin and fluorouracil (PF) prior to concurrent chemoradiotherapy.

The primary endpoint of failure-free survival (FFS) showed a significant advantage for the TPC regimen. The 5-year FFS rate was 77.6% in the TPC cohort compared to 62.9% in the PF group, supported by a hazard ratio of 0.52.

Secondary outcomes further supported the superiority of TPC. Patients receiving TPC showed higher rates of distant metastasis-free survival (87.8% vs 78.8%) and locoregional relapse-free survival (92.0% vs 82.1%). Overall survival was also notably higher in the TPC group at 89.6% compared to 82.2% for those receiving PF.

Safety profiles were comparable between both treatment arms, with grade 3 or 4 adverse events occurring in approximately 57.6% of the TPC group and 65.8% of the PF group. Treatment adherence remained consistent across cohorts, suggesting that TPC is a tolerable and effective alternative for managing high-risk LA-NPC.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in current management of nasopharyngeal carcinoma by comparing two specific induction chemotherapy regimens (TPC vs. PF). While previous coverage has addressed other head and neck cancers, such as advanced esophageal squamous-cell carcinoma where toripalimab plus paclitaxel and cisplatin improved overall survival, this study specifically evaluates the addition of capecitabine to the standard cisplatin and paclitaxel backbone for high-risk LA-NPC.

Researchers conducted a multicenter randomized trial involving 238 patients with high-risk locoregionally advanced nasopharyngeal carcinoma. The study compared two different treatment paths: one using paclitaxel, cisplatin, and capecitabine (TPC) followed by chemoradiotherapy, and another using cisplatin and fluorouracil (PF) followed by the same radiation therapy.

The results showed that patients who received the TPC combination had higher rates of failure-free survival compared to those who received the PF combination. Specifically, 77.6% of patients in the TPC group achieved failure-free survival, while 62.9% did in the PF group. The study also noted higher rates of distant metastasis-free survival and locoregional relapse-free survival for those receiving the TPC treatment.

Regarding safety, both groups experienced similar levels of severe side effects. About 57.6% of patients in the TPC group and 65.8% in the PF group experienced high-grade adverse events. While the results show a link between the TPC regimen and better outcomes, these findings are based on one trial. Patients should discuss these specific chemotherapy combinations with their oncology team to determine the best plan for their individual needs.

What this means for you:

The TPC chemotherapy combination showed higher survival rates than the PF option in this clinical trial.

Common questions

What is the difference between TPC and PF treatments?

The TPC treatment uses a combination of paclitaxel, cisplatin, and capecitabine before chemoradiotherapy. The PF treatment uses cisplatin and fluorouracil followed by chemoradiotherapy. This study found that patients receiving the TPC combination had higher rates of failure-free survival (77.6%) compared to those receiving the PF combination (62.9%).

Are there significant side effects with these treatments?

Both treatment groups showed similar levels of tolerability. In the TPC group, 57.6% of patients experienced Grade 3 or 4 adverse events, while 65.8% of patients in the PF group experienced those same high-grade side effects. You should speak with your doctor about managing these risks.

How did the study measure success for patients?

The trial measured several outcomes, including failure-free survival, distant metastasis-free survival, and locoregionally relapse-free survival. The TPC group showed higher percentages in all three categories compared to the PF group. These results were tracked over a median follow-up period of 89.1 months.

Study Details

Study typeRct

Sample sizen = 118

EvidenceLevel 2

Follow-up60.0 mo

PublishedSep 2026

PMID42640170

TrialNCT02940925

View Original Abstract ↓

BACKGROUND: We previously reported higher failure-free survival (FFS) with induction paclitaxel, cisplatin, and capecitabine (TPC) compared with cisplatin and fluorouracil (PF) in high-risk locoregionally advanced nasopharyngeal carcinoma (LA-NPC). We now report 5-year FFS, with prespecified secondary outcomes. METHODS: In this multicenter, randomized trial, patients with high-risk LA-NPC (TNM or TNM) received two 21-day cycles of induction chemotherapy with TPC or PF, followed by concurrent chemoradiotherapy. The primary endpoint was FFS; secondary endpoints included distant metastasis-free, locoregional relapse-free, and overall survival (OS), tumor response, and safety. RESULTS: Among 238 patients (TPC, n=118; PF, n=120), with median follow-up of 89.1 months, 5-year FFS was 77.6% in the TPC group and 62.9% in the PF group (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.34-0.82). At 5 years, distant metastasis-free survival was 87.8% in the TPC group and 78.8% in the PF group (HR, 0.51; 95% CI, 0.28-0.95); locoregional relapse-free survival was 92.0% and 82.1%, respectively (HR, 0.43; 95% CI, 0.21-0.88); and OS was 89.6% and 82.2%, respectively (HR, 0.51; 95% CI, 0.27-0.95). Among patients with pretreatment Epstein-Barr virus (EBV) DNA <3000 copies/ml, 5-year OS was 92.3% in the TPC group and 84.4% in the PF group. Among those with higher EBV DNA levels, rates were 84.2% in TPC group and 81.1% in PF group. Grade 3 or 4 adverse events occurred in 68 patients (57.6%) receiving TPC and 79 patients (65.8%) receiving PF. Treatment adherence was similar in the two groups. CONCLUSIONS: Among patients with high-risk LA-NPC, TPC induction chemotherapy was associated with higher 5-year FFS than PF. (Funded by National Natural Science Foundation of China and State Key Laboratory of Respiratory Disease; ClinicalTrials.gov number, NCT02940925.).

Paclitaxel and Cisplatin Combination Improves Outcomes in Locoregionally Advanced Nasopharyngeal CarcinomaTrial shows TPC chemotherapy improves survival for nasopharyngeal carcinoma

How this fits prior evidence

Common questions

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Paclitaxel and Cisplatin Combination Improves Outcomes in Locoregionally Advanced Nasopharyngeal CarcinomaTrial shows TPC chemotherapy improves survival for nasopharyngeal carcinoma

How this fits prior evidence

Common questions

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