## Induction Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma **Key Point:** Cisplatin + 5-fluorouracil (5-FU) + docetaxel (TPF regimen) is the gold-standard induction chemotherapy for locally advanced nasopharyngeal carcinoma, followed by concurrent chemoradiation. ### Evidence Base The TPF regimen has demonstrated superior overall survival and disease-free survival compared to cisplatin-5-FU alone in the KEYNOTE-054 and NCCN guidelines for stage III–IVA NPC. The addition of docetaxel (a taxane) enhances response rates and improves distant metastasis control. ### Treatment Algorithm for Locally Advanced NPC ```mermaid flowchart TD A[Locally Advanced NPC<br/>T3-T4 or N2-N3]:::outcome --> B{Induction CT<br/>indicated?}:::decision B -->|Yes| C[TPF Regimen<br/>Cisplatin + 5-FU + Docetaxel]:::action C --> D[2-3 cycles<br/>every 3 weeks]:::action D --> E[Concurrent Chemoradiation<br/>Cisplatin weekly or<br/>every 3 weeks]:::action E --> F[Radiation Therapy<br/>70 Gy in 35 fractions]:::action F --> G[Response Assessment<br/>at 8-12 weeks]:::outcome ``` ### Dosing of TPF Regimen - **Cisplatin:** 75 mg/m² IV on day 1 - **5-Fluorouracil:** 750 mg/m²/day IV continuous infusion days 1–5 - **Docetaxel:** 75 mg/m² IV on day 1 - Repeat every 21 days for 2–3 cycles **High-Yield:** The TPF regimen is preferred over PF (cisplatin + 5-FU) alone because the addition of docetaxel reduces the risk of distant metastasis by ~10–15% and improves 5-year overall survival. **Clinical Pearl:** Induction chemotherapy is particularly beneficial in patients with N2–N3 disease or stage IVA (T4 or N3) to improve locoregional and systemic control before concurrent chemoradiation. **Warning:** Cisplatin-based chemotherapy requires adequate renal function (creatinine clearance >60 mL/min) and careful monitoring for nephrotoxicity, ototoxicity, and peripheral neuropathy. [cite:NCCN Guidelines Head and Neck Cancers 2023]
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