Efficacy and Safety of Nanoparticle Albumin-Bound Paclitaxel Compared to Docetaxel Plus Nedaplatin as Induction Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma: A Propensity Score Matching Analysis

Purpose: This study aimed to compare the long-term efficacy and safety of nanoparticle albumin-bound paclitaxel plus nedaplatin (NP) versus docetaxel plus nedaplatin (TP) as induction chemotherapy (IC) for locally advanced nasopharyngeal carcinoma (LA NPC). Methods: In this retrospective analysis, treatment-naïve patients with stage III–IVa NPC who received IC with either NP or TP regimen between December 2018 and January 2021 were enrolled. Propensity score matching (PSM) was applied to balance baseline characteristics, resulting in 70 matched pairs. Efficacy endpoints included overall survival (OS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS). Treatment-related adverse events (AEs) were graded per CTCAE v5.0. Results: After a median follow-up of 68.6 months, the 5-year OS (89.98% vs 86.98%, P=0.610), LRFS (94.06% vs 96.69%, P=0.424), and DMFS (91.33% vs 85.61%, P=0.308) rates were comparable between the NP and TP groups. Multivariable analysis confirmed that the treatment regimen was not an independent prognostic factor. The toxicity profiles, however, differed significantly. The TP group had a higher incidence of any-grade neutropenia (68.6% vs 50.0%, P=0.047), while the NP group was associated with more frequent any-grade peripheral sensory neuropathy (57.1% vs 0.0%, P< 0.001) and myalgia (45.7% vs 1.4%, P< 0.001). The rates of severe (grade 3– 4) hematological toxicities were similar between the groups. Conclusion: The NP regimen demonstrated comparable long-term survival outcomes to the TP regimen as IC for LA NPC, with a distinct toxicity profile. NP may serve as a valuable alternative, offering a favorable hematological toxicity profile and eliminating the need for corticosteroid premedication, albeit with a higher incidence of low-grade neurotoxicity and myalgia. Keywords: nasopharyngeal carcinoma, neoadjuvant chemotherapy, concurrent chemoradiotherapy