Chemotherapy with cisplatin and continuous infusion of 5-fluorouracil and bleomycin for recurrent and metastatic nasopharyngeal carcinoma in Taiwan

Twenty-five patients with metastatic and/or recurrent nasopharyngeal car-cinoma were treated with cisplatin 20 mg/m2/day on days 1-5 i.v. with hydra-tion; 5-fluorouracil (5-FU) 1, 000 mg/m2/day by continuous infusion (CI); and bleomycin 15 mg/m2 on day 1 also by CI. These cycles were repeated every 4 weeks. Twenty-three (92%) had distant metastases. Bone was the most fre-quently involved site (72%), followed by lungs (44%) and liver (40%). More than half the patients (14/25) presented with at least 3 organ sites involved or had local T3/T4 or N3 lesions with a distant metastasis. The median time from relapse to start of chemotherapy was 7.5 months. We observed 1 (4%) complete response (CR), and 9 (36%) partial responses (PR). The objective response rate (CR + PR) was 40%. Hematologic toxicities were frequently encountered. Twenty (80%) patients experienced leukopenia during the treatment courses and 9 (36%) had severe (grade 3 or 4) leukopenia. Eight patients had grade 3 or 4 infections. Two of them died of sepsis and 1 succumbed to uncontrolled pneumonia. The objective response rate was inferior to other series. Possible explanation included longer delay before initiation of definitive treatment, larger tumor burdens, higher severe hematologic toxicity and lower dosage of bleomycin. The results suggested metastatic and/or recurrent nasopharyngeal carcinoma is chemosensitive, however, for patients with large tumor burdens, more intensive chemotherapy regimens with support of hematopoietic growth factors may be required to achieve a better control.