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.
Chemotherapy
Head and Neck Cancer
Individual Patient Data
Meta-analysis
Radiotherapy
Randomised Clinical Trials
Journal
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
15
10
2020
revised:
22
12
2020
accepted:
08
01
2021
pubmed:
31
1
2021
medline:
24
4
2021
entrez:
30
1
2021
Statut:
ppublish
Résumé
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. Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT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. 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). The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
Sections du résumé
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.
Identifiants
pubmed: 33515668
pii: S0167-8140(21)00013-X
doi: 10.1016/j.radonc.2021.01.013
pmc: PMC8386522
mid: NIHMS1725704
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
281-293Subventions
Organisme : NCI NIH HHS
ID : U10 CA180868
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NCI NIH HHS
ID : UG1 CA233160
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180820
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180794
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180888
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180819
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180822
Pays : United States
Investigateurs
D J Adelstein
(DJ)
M Alfonsi
(M)
Y Belkacemi
(Y)
V Bar-Ad
(V)
J Bernier
(J)
Å Bratland
(Å)
G Calais
(G)
B Campbell
(B)
J Caudell
(J)
S Chabaud
(S)
E Chamorey
(E)
D Chaukar
(D)
K N Choi
(KN)
O Choussy
(O)
L Collette
(L)
J J Cruz
(JJ)
C Dani
(C)
E Dauzier
(E)
A A Forastiere
(AA)
P Garaud
(P)
V Gregoire
(V)
A Hackshaw
(A)
E Haddad
(E)
B G Haffty
(BG)
A Hansen
(A)
S Hayoz
(S)
J C Horiot
(JC)
B Jeremic
(B)
T G Karrison
(TG)
J A Langendijk
(JA)
M Lapeyre
(M)
E Lartigau
(E)
T Leong
(T)
Q T Le
(QT)
P P Y Lee
(PPY)
F Lewin
(F)
A Lin
(A)
A Lopes
(A)
S Mehta
(S)
J Moon
(J)
E Moyal
(E)
B V Occéan
(BV)
P Olmi
(P)
R Orecchia
(R)
B O'Sullivan
(B)
J Overgaard
(J)
C Petit
(C)
H Quon
(H)
G Sanguineti
(G)
T Satar
(T)
J Simes
(J)
C Simon
(C)
C Sire
(C)
S Staar
(S)
C Stromberger
(C)
P Strojan
(P)
S Temam
(S)
D Thomson
(D)
A Timochenko
(A)
V Torri
(V)
V Tseroni
(V)
J Vermorken
(J)
E E Vokes
(EE)
J Waldron
(J)
K D Wernecke
(KD)
J Widder
(J)
B Zackrisson
(B)
Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest 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.
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