CHAN-2018

Regimen

Experimental
Adjuvant cisplatin + gemcitabine ×6 cycles in patients with detectable post-RT EBV DNA
Control
Observation in patients with detectable post-RT EBV DNA (patients with undetectable EBV DNA underwent standard surveillance outside the randomisation)

Population

NPC stage IIB-IVB with detectable plasma EBV DNA at 6-8 weeks post-radiotherapy (high-risk residual molecular disease), Hong Kong multicentre

Key finding

Tested the conceptually attractive hypothesis that post-RT plasma EBV DNA can identify high-risk patients for adjuvant chemotherapy. Although the EBV-DNA screening rate was high (27.4% detectable post-RT, indicating micrometastatic burden), adjuvant GC did not improve relapse-free survival in this molecularly-selected group. The trial was underpowered (only 104 randomised from 789 screened) and the choice of GC doublet as adjuvant may have been suboptimal. The negative result dampened enthusiasm for EBV-guided adjuvant escalation strategies but confirmed that post-RT EBV DNA level independently predicts all failure types.

Source: PMID 29989858

Timeline

    Guideline citations

    • NCCN NPC (p.188)