Pre-Surgery Chemotherapy Boosts Organ Preservation in Rare Nose and Sinus Cancer

In a promising development for patients with advanced squamous cell carcinoma of the nose and sinuses, a recent clinical trial led by the ECOG-ACRIN Cancer Research Group found that pre-surgery chemotherapy significantly improves chances of preserving critical structures, such as the eye and skull base. This randomized trial, known as EA3163, was highlighted at the European Society of Medical Oncology Congress 2024 and sheds new light on potential treatment approaches for a cancer that often requires highly invasive surgeries with substantial long-term effects.

The EA3163 trial demonstrated that administering chemotherapy before surgery increased the likelihood of preserving vital structures to 50%, compared to just 15% with the traditional approach of surgery followed by radiation alone. Conducted at multiple centers in the United States, the trial enrolled patients with severe tumors for whom surgery would otherwise mean a high risk of losing essential structures, including the eye or portions of the skull. Patients in the chemotherapy group received three cycles of treatment with docetaxel and cisplatin (or carboplatin as an alternative) before surgery, followed by radiation therapy, which was administered at 66 Gy. In contrast, the control group received surgery followed by a slightly lower radiation dose of 60 Gy.

This approach is noteworthy as it represents one of the first large-scale, multi-center trials focused on pre-surgery chemotherapy for this rare and aggressive cancer, which affects only around 2,000 people in the United States annually. The rarity of nasal and sinus cancer and its tendency to invade areas near the eyes and skull base has historically made treatment options limited and invasive. Standard treatment often leaves patients with severe, life-long impacts on quality of life. As Dr. Nabil F. Saba, lead investigator and head of the Head and Neck Oncology Program at Emory University, noted, this trial provides critical evidence supporting neoadjuvant chemotherapy as a viable way to improve treatment outcomes by enhancing organ preservation.

The findings from the EA3163 trial are significant for clinicians treating nasal and sinus squamous cell carcinoma, as preserving essential structures not only benefits physical health but also improves patients’ quality of life post-surgery. With a current five-year survival rate below 50%, the potential for reducing morbidity offers hope for a population with few effective options. Dr. Saba and his team emphasize that, while the study had limited enrollment due to the rarity of the disease, the results still strongly support chemotherapy’s role in organ preservation. Future research may explore variations in chemotherapy drugs or adding immunotherapy to further enhance these outcomes.

As survival data continues to be monitored, the EA3163 trial could shift treatment paradigms for nasal and sinus cancers, encouraging broader use of chemotherapy before surgery to preserve critical anatomy and function in affected patients.