Role of chemotherapy in patients with nasopharynx carcinoma treated with radiotherapy (MAC-NPC): an updated individual patient data network meta-analysis.

Autor:	Petit C; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France., Lee A; Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, 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, China., Lacas B; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France., Ng WT; Clinical Oncology Center, University of Hong Kong-Shenzhen Hospital, University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China., Chan ATC; State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China., Hong RL; Department of Medical Oncology, National Taiwan University Cancer Center, 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., Tan T; National Cancer Center, Singapore., Ngan RKC; Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China., Zhu G; Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, China., Mai HQ; Sun Yat-sen University Cancer Center, Guangzhou, China., Hui EP; State Key Laboratory of Translational Oncology, Hong Kong Cancer Institute, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China., Fountzilas G; Aristotle University of Thessaloniki, Thessaloniki, Greece; Hellenic Cooperative Oncology Group, Athens, Greece; German Oncology Center, Limassol, Cyprus., Zhang L; Sun Yat-sen University Cancer Center, Guangzhou, China., Carmel A; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France., Kwong DLW; Department of Clinical Oncology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China., Moon J; Southwest Oncology Group Statistics and Data Management Center, Seattle, WA, USA., Bourhis J; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France; Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Auperin A; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France., Pignon JP; Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France., Blanchard P; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave Roussy, Villejuif, France; Oncostat U1018 INSERM, Ligue Nationale Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France. Electronic address: pierre.blanchard@gustaveroussy.fr.
Jazyk:	angličtina
Zdroj:	The Lancet. Oncology [Lancet Oncol] 2023 Jun; Vol. 24 (6), pp. 611-623.
DOI:	10.1016/S1470-2045(23)00163-8
Abstrakt:	Background: The meta-analysis of chemotherapy for nasopharynx carcinoma (MAC-NPC) collaborative group previously showed that the addition of adjuvant chemotherapy to concomitant chemoradiotherapy had the highest survival benefit of the studied treatment regimens in nasopharyngeal carcinoma. Due to the publication of new trials on induction chemotherapy, we updated the network meta-analysis. Methods: For this individual patient data network meta-analysis, trials of radiotherapy with or without chemotherapy in patients with non-metastatic nasopharyngeal carcinoma that completed accrual before Dec 31, 2016, were identified and updated individual patient data were obtained. Both general databases (eg, PubMed and Web of Science) and Chinese medical literature databases were searched. Overall survival was the primary endpoint. A frequentist network meta-analysis approach with a two-step random effect stratified by trial based on hazard ratio Peto estimator was used. Global Cochran Q statistic was used to assess homogeneity and consistency, and p score to rank treatments, with higher scores indicating higher benefit therapies. Treatments were grouped into the following categories: radiotherapy alone, induction chemotherapy followed by radiotherapy, induction chemotherapy without taxanes followed by chemoradiotherapy, induction chemotherapy with taxanes followed by chemoradiotherapy, chemoradiotherapy, chemoradiotherapy followed by adjuvant chemotherapy, and radiotherapy followed by adjuvant chemotherapy. This study is registered with PROSPERO, CRD42016042524. Findings: The network comprised 28 trials and included 8214 patients (6133 [74·7%] were men, 2073 [25·2%] were women, and eight [0·1%] had missing data) enrolled between Jan 1, 1988, and Dec 31, 2016. Median follow-up was 7·6 years (IQR 6·2-13·3). There was no evidence of heterogeneity (p=0·18), and inconsistency was borderline (p=0·10). The three treatments with the highest benefit for overall survival were induction chemotherapy with taxanes followed by chemoradiotherapy (hazard ratio 0·75; 95% CI 0·59-0·96; p score 92%), induction chemotherapy without taxanes followed by chemoradiotherapy (0·81; 0·69-0·95; p score 87%), and chemoradiotherapy followed by adjuvant chemotherapy (0·88; 0·75-1·04; p score 72%), compared with concomitant chemoradiotherapy (p score 46%). Interpretation: The inclusion of new trials modified the conclusion of the previous network meta-analysis. In this updated network meta-analysis, the addition of either induction chemotherapy or adjuvant chemotherapy to chemoradiotherapy improved overall survival over chemoradiotherapy alone in nasopharyngeal carcinoma. Funding: Institut National du Cancer and Ligue Nationale Contre le Cancer. Competing Interests: Declaration of interests AA reports payment to her institution by MSD France for the participation on a data safety monitoring board or advisory board. P-YH reports grants from JunShi Pharm, outside the submitted work. CP reports a fellow grant from Fondation de France, outside the submitted work. LZ reports research grants from Hengrui Pharm, Beigen Pharm, and Eli Lilly. JMo reports a grant from the US National Cancer Institute to SWOG Statistics and Data Management Center. RKCN reports consulting fees from Pfizer, Novartis, Sanofi, AstraZeneca, Eli Lilly, MSD, Zai Lab, Roche, Eisai, and Merck; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novartis, AstraZeneca, Sanofi, Pfizer, Zai Lab, Eisai, Eli Lilly, and MSD; support for attending meetings or travel from Pfizer, Astellas, Novartis, MSD, Roche, Eisai, Merck, Sanofi, Bristol Myers Squibb (BMS), and ZaiLab; payment to his institution from Nuance for participation on a data safety monitoring board or advisory board. GF reports payment from Novartis for an advisory role, and stock or stock options from Genprex, Daiichi Sankyo, Ariad, RFL Holdings, and Formycon. ATCC reports grants to his institution from Merck Serono, MSD, Novartis, Pfizer, and Eli Lilly; consulting fees from MSD, Merck Serono, and Cullinan Management; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Beigene, Springer, Merck, and Pfizer; support for attending meetings or travel from BMS, MSD, Pfizer, Roche, Novartis, and AstraZeneca; participation on a data safety monitoring board or advisory board from MSD and Tessa Therapeutics; and other non-financial interests from Immunomic Therpeutics, Angene Biotechnology, and Owlstone Medical. JB reports consulting fees from Merck, MSD, Roche, BMS, and Nanobiotix. All other authors declare no competing interests. (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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