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.
Details
Serval ID
serval:BIB_0FC45D6CCFAA
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
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.
Journal
Radiotherapy and oncology
Working group(s)
MACH-NC Collaborative Group
Contributor(s)
Adelstein D.J., Alfonsi M., Belkacemi Y., Bar-Ad V., Bernier J., Bratland Å., 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 PPY, Lewin F., Lin A., Lopes A., Mehta S., Moon J., Moyal E., Occéan 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.
ISSN
1879-0887 (Electronic)
ISSN-L
0167-8140
Publication state
Published
Issued date
03/2021
Peer-reviewed
Oui
Volume
156
Pages
281-293
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
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Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT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.
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.
Keywords
Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Squamous Cell/drug therapy, Chemotherapy, Adjuvant, Head and Neck Neoplasms/therapy, Humans, Induction Chemotherapy, Randomized Controlled Trials as Topic, Chemotherapy, Head and Neck Cancer, Individual Patient Data, Meta-analysis, Radiotherapy, Randomised Clinical Trials
Pubmed
Web of science
Create date
08/02/2021 14:13
Last modification date
13/10/2021 5:43
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