TPF induction (docetaxel/cisplatin/5-FU) fails to beat PF adjuvant after CCRT in LA-NPC, with more myelosuppression

TPF is a taxane–platinum–fluoropyrimidine triplet induction chemotherapy regimen given pre-radiation, while PF (cisplatin/5-fluorouracil) is a platinum–fluoropyrimidine doublet commonly used in older concurrent/adjuvant paradigms. In this multicenter China-based Phase III trial (NCT03574324), 266 patients with locally advanced nasopharyngeal carcinoma were randomized to TPF→CCRT vs CCRT→PF; 3-year PFS was not significantly different (79% vs 74.5%, p=0.454; median follow-up 39 months), with similarly nonsignificant OS/LRFS/DMFS. Symptom toxicities during CCRT favored induction (any-grade nausea/vomiting 77.1% vs 89.1%; swallowing toxicity 30.5% vs 43.8%; xerostomia 44.3% vs 67.2%), but grade 3–4 leukopenia (44.3% vs 21.9%) and neutropenia (59.5% vs 18.8%) were higher with TPF—overall landing in the “no clear efficacy win” range seen in other induction-vs-adjuvant comparisons in high-risk LA-NPC (~70%–74% 3-year PFS with either sequencing), while today’s more common induction benchmark in endemic regions is often gemcitabine/cisplatin (GP) with recurrence-free/FFS advantages vs CCRT alone rather than PF adjuvant.