Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group
Articolo
Data di Pubblicazione:
2021
Abstract:
Background and purpose: The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results. Materials and methods: Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint. Results: For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005). Conclusion: The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
Tipologia CRIS:
03A-Articolo su Rivista
Keywords:
Chemotherapy; Head and Neck Cancer; Individual Patient Data; Meta-analysis; Radiotherapy; Randomised Clinical Trials
Elenco autori:
Lacas B.; Carmel A.; Landais C.; Wong S.J.; Licitra L.; Tobias J.S.; Burtness B.; Ghi M.G.; Cohen E.E.W.; Grau C.; Wolf G.; Hitt R.; Corvo R.; Budach V.; Kumar S.; Laskar S.G.; Mazeron J.-J.; Zhong L.-P.; Dobrowsky W.; Ghadjar P.; Fallai C.; Zakotnik B.; Sharma A.; Bensadoun R.-J.; Ruo Redda M.G.; Racadot S.; Fountzilas G.; Brizel D.; Rovea P.; Argiris A.; Nagy Z.T.; Lee J.-W.; Fortpied C.; Harris J.; Bourhis J.; Auperin A.; Blanchard P.; Pignon J.-P.; Adelstein D.J.; Alfonsi M.; Belkacemi Y.; Bar-Ad V.; Bernier J.; Bratland A.; Calais G.; Campbell B.; Caudell J.; Chabaud S.; Chamorey E.; Chaukar D.; Choi K.N.; Choussy O.; Collette L.; Cruz J.J.; Dani C.; Dauzier E.; Forastiere A.A.; Garaud P.; Gregoire V.; Hackshaw A.; Haddad E.; Haffty B.G.; Hansen A.; Hayoz S.; Horiot J.C.; Jeremic B.; Karrison T.G.; Langendijk J.A.; Lapeyre M.; Lartigau E.; Leong T.; Le Q.T.; Lee P.P.Y.; Lewin F.; Lin A.; Lopes A.; Mehta S.; Moon J.; Moyal E.; Occean B.V.; Olmi P.; Orecchia R.; O'Sullivan B.; Overgaard J.; Petit C.; Quon H.; Sanguineti G.; Satar T.; Simes J.; Simon C.; Sire C.; Staar S.; Stromberger C.; Strojan P.; Temam S.; Thomson D.; Timochenko A.; Torri V.; Tseroni V.; Vermorken J.; Vokes E.E.; Waldron J.; Wernecke K.D.; Widder J.; Zackrisson B.
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