학술논문
Meta-analysis of chemotherapy in nasopharynx carcinoma (MAC-NPC): An update on 26 trials and 7080 patients
Document Type
article
Author
Pierre Blanchard; Anne W.M. Lee; Alexandra Carmel; Ng Wai Tong; Jun Ma; Anthony T.C. Chan; Ruey Long Hong; Ming-Yuan Chen; Lei Chen; Wen-Fei Li; Pei-Yu Huang; Dora L.W. Kwong; Sharon S.X. Poh; Roger Ngan; Hai-Qiang Mai; Camille Ollivier; George Fountzilas; Li Zhang; Jean Bourhis; Anne Aupérin; Benjamin Lacas; Jean-Pierre Pignon; Ellen Benhamou; Somvilai Chakrabandhu; Anthony TC Chan; Qiu-Yan Chen; Yong Chen; Richard J Chappell; Horace Choi; Daniel TT Chua; Melvin Lee Kiang Chua; Julian Higgins; Ming-Huang Hong; Ruey-Long Hong; Edwin Pun Hui; C.F. Hsiao; Michael Kam; Georgia Angeliki Koliou; Dora LW Kwong; Shu-Chuan Lai; Ka On Lam; Michael L LeBlanc; Anne WM Lee; Ho Fun Victor Lee; Wen Fei Li; Brigette Ma; Frankie Mo; James Moon; Wai Tong Ng; Brian O'Sullivan; Claire Petit; Jean Pierre Pignon; Sharon X. Poh; Gerta Rücker; Jonathan Sham; Yoke Lim Soong; Ying Sun; Terence Tan; Lin-Quan Tang; Yuk Tung; Joseph Wee; Xuang Wu; Tingting Xu; Yuan Zhang; Guopei Zhu
Source
Clinical and Translational Radiation Oncology, Vol 32, Iss , Pp 59-68 (2022)
Subject
Language
English
ISSN
2405-6308
Abstract
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 Methods: Published or unpublished randomized trials assessing radiotherapy (±a second chemotherapy timing) with/without chemotherapy in non-metastatic NPC patients were identified.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.