Meta-analysis of chemotherapy in nasopharynx carcinoma (MAC-NPC): An update on 26 trials and 7080 patients.

Autor:	Blanchard P; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, Villejuif, France Gustave-Roussy, Villejuif, France.; Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France., Lee AWM; University of Hong Kong - Shenzhen Hospital, University of Hong-Kong, China., Carmel A; Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France., Wai Tong N; University of Hong Kong - Shenzhen Hospital, University of Hong-Kong, China., Ma J; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China., Chan ATC; State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, China., Hong RL; National Taiwan University Hospital, Taipei, Taiwan., Chen MY; Sun Yat-sen University Cancer Center, Guangzhou, China., Chen L; Sun Yat-sen University Cancer Center, Guangzhou, China., Li WF; Sun Yat-sen University Cancer Center, Guangzhou, China., Huang PY; Sun Yat-sen University Cancer Center, Guangzhou, China., Kwong DLW; Department of Clinical Oncology, University of Hong Kong, Hong Kong, China., Poh SSX; National Cancer Center, Singapore., Ngan R; University of Hong Kong - Shenzhen Hospital, University of Hong-Kong, China., Mai HQ; Sun Yat-sen University Cancer Center, Guangzhou, China., Ollivier C; Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France., Fountzilas G; Aristotle University of Thessaloniki School of Medicine, Thessaloniki, and Hellenic Cooperative Oncology Group, Athens, Greece and German Oncology Center, Limassol, Cyprus., Zhang L; Sun Yat-sen University Cancer Center, Guangzhou, China., Bourhis J; Department of Radiotherapy, Centre hospitalier universitaire vaudois, Lausanne, Switzerland., Aupérin A; Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France., Lacas B; Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France., Pignon JP; Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Villejuif, France.; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France.
Jazyk:	angličtina
Zdroj:	Clinical and translational radiation oncology [Clin Transl Radiat Oncol] 2021 Nov 26; Vol. 32, pp. 59-68. Date of Electronic Publication: 2021 Nov 26 (Print Publication: 2022).
DOI:	10.1016/j.ctro.2021.11.007
Abstrakt:	Purpose: Chemotherapy, when added to radiotherapy, improves survival in locally advanced nasopharyngeal carcinoma (NPC). This article presents the second update of the Meta-Analysis of Chemotherapy in NPC. Methods: Published or unpublished randomized trials assessing radiotherapy (±a second chemotherapy timing) with/without chemotherapy in non-metastatic NPC patients were identified. Updated data were sought for studies included in the previous rounds of the meta-analysis. The primary endpoint was overall survival. All trials were analyzed following the intent-to-treat principle using a fixed-effects model. Treatments were classified in five subsets according to chemotherapy timing. The statistical analysis plan was pre-specified. Results: Eighteen new trials were identified. Individual patient data were available for seven. In total, the meta-analysis now included 26 trials and 7,080 patients. The addition of chemotherapy reduced the risk of death, with a hazard ratio (HR) of 0.79 (95% confidence interval (CI) [0.73; 0.85]), and an absolute survival increase at 5 and 10 years of 6.1% [+3.9; +8.3] and + 8.4% [+5.7; +11.1], respectively. The largest effect was observed for concomitant + adjuvant, induction (with concomitant in both arms) and concomitant chemotherapy, with respective HR [95%CI] of 0.68 [0.59; 0.79] (absolute survival increase at 5 years: 12.3% (7.0%;17.6%)), 0.73 [0.63; 0.86] (6.0% (2.5%;9.5%)) and 0.81 [0.70; 0.92] (5.2% (0.8%;9.6%)). The benefit of chemotherapy was also demonstrated by improvement in progression-free survival, cancer mortality, locoregional control and distant control. There was a significant interaction between patient age and chemotherapy effect. Conclusion: This updated meta-analysis confirms the benefit of concomitant chemotherapy and concomitant + adjuvant chemotherapy, and suggests that addition of induction or adjuvant chemotherapy to concomitant chemotherapy improves tumor control and survival. The benefit of chemotherapy decreases with increasing patient age. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2021 The Authors.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu