Meta-analysis of chemotherapy in nasopharynx carcinoma (MAC-NPC): An update on 26 trials and 7080 patients. (January 2022)

• Record Type: Journal Article
• Authors: Blanchard, Pierre; Lee, Anne W.M.; Carmel, Alexandra; Wai Tong, Ng; Ma, Jun; Chan, Anthony T.C.; Hong, Ruey Long; Chen, Ming-Yuan; Chen, Lei; Li, Wen-Fei; Huang, Pei-Yu; Kwong, Dora L.W.; Poh, Sharon S.X.; Ngan, Roger; Mai, Hai-Qiang; Ollivier, Camille; Fountzilas, George; Zhang, Li; Bourhis, Jean; Aupérin, Anne; Lacas, Benjamin; Pignon, Jean-Pierre; Aupérin, Anne; Blanchard, Pierre; Benhamou, Ellen; Bourhis, Jean; Carmel, Alexandra; Chakrabandhu, Somvilai; TC Chan, Anthony; Chen, Lei; Chen, Ming-Yuan; Chen, Qiu-Yan; Chen, Yong; Chappell, Richard J; Choi, Horace; TT Chua, Daniel; Lee Kiang Chua, Melvin; Fountzilas, George; Higgins, Julian; Hong, Ming-Huang; Hong, Ruey-Long; Huang, Pei-Yu; Pun Hui, Edwin; Hsiao, C.F.; Kam, Michael; Angeliki Koliou, Georgia; LW Kwong, Dora; Lacas, Benjamin; Lai, Shu-Chuan; On Lam, Ka; LeBlanc, Michael L; WM Lee, Anne; Fun Victor Lee, Ho; Fei Li, Wen; Ma, Brigette; Ma, Jun; Mai, Hai-Qiang; Mo, Frankie; Moon, James; Tong Ng, Wai; Ngan, Roger; Ollivier, Camille; O'Sullivan, Brian; Petit, Claire; Pierre Pignon, Jean; Poh, Sharon X.; Rücker, Gerta; Sham, Jonathan; Lim Soong, Yoke; Sun, Ying; Tan, Terence; Tang, Lin-Quan; Tung, Yuk; Wee, Joseph; Wu, Xuang; Xu, Tingting; Zhang, Li; Zhang, Yuan; Zhu, Guopei;
• Is Part Of: Clinical and translational radiation oncology. Volume 32(2022)
• Page Start: 59
• Page End: 68
• Publication Date: 2022-01
• Subjects: Individual patient data -- Meta-analysis -- Randomized trials -- Chemotherapy -- Nasopharynx carcinoma; Cancer -- Radiotherapy -- Periodicals; Oncology -- Periodicals; Cancer -- Radiotherapy; Oncology; Radiation Oncology; Neoplasms -- radiotherapy; Translational Medical Research; Periodicals; Electronic journals; Periodicals; 616.9940642
• DOI: 10.1016/j.ctro.2021.11.007
• Languages: English
• ISSNs: 2405-6308

Abstract

Highlights: Individual patient data meta-analysis including 26 trials and 7, 080 patients with locally advanced nasopharyngeal carcinoma. Addition of chemotherapy reduced the risk of death with an absolute survival increase at 5 and 10 years of 6.1% and 8.4% The benefit of chemotherapy was also demonstrated by improvements in progression-free survival, cancer mortality, locoregional control and distant control. The largest effect was observed for concomitant + adjuvant, induction (with concomitant in both arms) and concomitant chemotherapy. Chemotherapy benefit decreased with increasing patient age. 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.