San-Gang Wu

doi:10.4143/crt.2024.1048

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Correspondence Reply to Commentary on “Metronomic S-1 Adjuvant Chemotherapy Improves Survival in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma”: San-Gang Wu; DOI: https://doi.org/10.4143/crt.2024.1048
Published online: November 4, 2024

Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

Correspondence: San-Gang Wu, Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
Tel: 86-5922139531 Fax: 86-59221397047 E-mail: wusg@xmu.edu.cn

• Received: October 28, 2024 • Accepted: October 31, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the letter "Commentary on “Metronomic S-1 Adjuvant Chemotherapy Improves Survival in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma”".

Thank you for your valuable feedback on our article. There is still ongoing controversy regarding the definition of endpoints in clinical research. In our study, the primary endpoint was disease-free survival (DFS), defined as the time from the date of diagnosis to the confirmation of locoregional recurrence (LRR) or distant metastasis (DM). The secondary endpoints included locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and safety. OS was defined as the time from the date of diagnosis to the date of death from any cause, or the last known date when the patient was alive. LRFS referred to the time from diagnosis to the date of LRR, while DMFS referred to the time from diagnosis to the date of DM [1]. The correspondence from Dr. Erkan Topkan [2] indicated that death must also be considered an event in the results concerning LRFS, DMFS, and DFS.

Several prospective studies on nasopharyngeal carcinoma have used LRFS and DMFS as study outcomes, defining them as time to LRR or DM [3-5], rather than using death as the endpoint for LRFS and DMFS, as suggested by Dr. Erkan Topkan. Additionally, the definition of DFS in current literature remains controversial. Some definitions of DFS, similar to those by Delgado and Guddati [6], describe it as the “time from randomization to disease recurrence.” However, other definitions also include “the time until the date of death or first metastasis, progression, or recurrence” [5,7], which aligns with Dr. Erkan Topkan’s definition. Therefore, an accurate definition of survival endpoints can facilitate a more precise determination of patient survival outcomes and provide an important basis for the results of clinical studies.

We have redefined DFS to include patients who experienced death as one of its endpoints, yielding similar results before (p< 0.001) and after propensity score matching (p=0.005). We would like to express our gratitude once again to Dr. Erkan Topkan for providing valuable feedback on our research.

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Conflicts of Interest

Conflict of interest relevant to this article was not reported.

REFERENCES

1. Yu YF, Wu P, Zhuo R, Wu SG. Metronomic S-1 adjuvant chemotherapy improves survival in patients with locoregionally advanced nasopharyngeal carcinoma. Cancer Res Treat. 2024;56:1058–67. Article PubMed PMC PDF
2. Topkan E, Somay E, Durankus NK, Selek U. Commentary on “metronomic S-1 adjuvant chemotherapy improves survival in patients with locoregionally advanced nasopharyngeal carcinoma.”. Cancer Res Treat. 2024 Nov 4 [Epub]. https://doi.org/10.4143/crt.2024.779Article
3. Li WZ, Lv X, Hu D, Lv SH, Liu GY, Liang H, et al. Effect of induction chemotherapy with paclitaxel, cisplatin, and capecitabine vs cisplatin and fluorouracil on failure-free survival for patients with stage IVA to IVB nasopharyngeal carcinoma: a multicenter phase 3 randomized clinical trial. JAMA Oncol. 2022;8:706–14. Article PubMed PMC
4. Dai J, Zhang B, Su Y, Pan Y, Ye Z, Cai R, et al. Induction chemotherapy followed by radiotherapy vs chemoradiotherapy in nasopharyngeal carcinoma: a randomized clinical trial. JAMA Oncol. 2024;10:456–63. Article PubMed
5. Wang L, Zhuang H, Xu X, Zhou J, Jiao Y. Efficacy and survival analysis of nimotuzumab combined with concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Front Oncol. 2023;13:1129649.Article PubMed PMC
6. Delgado A, Guddati AK. Clinical endpoints in oncology: a primer. Am J Cancer Res. 2021;11:1121–31. PubMed PMC
7. Jin YN, Qiang MY, Wang Y, Lin YJ, Jiang RW, Cao WW, et al. The efficacy and safety of adding PD-1 blockade to induction chemotherapy and concurrent chemoradiotherapy (IC-CCRT) for locoregionally advanced nasopharyngeal carcinoma: an observational, propensity score-matched analysis. Cancer Immunol Immunother. 2024;73:125.Article PubMed PMC PDF

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Reply to Commentary on “Metronomic S-1 Adjuvant Chemotherapy Improves Survival in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma”

DOI: https://doi.org/10.4143/crt.2024.1048

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