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

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Benjamin Lacas, Cleveland Clinic Foundation, Institut Saint Catherine
  • ,
  • Alexandra Carmel, Cleveland Clinic Foundation
  • ,
  • Cécile Landais, Cleveland Clinic Foundation
  • ,
  • Stuart J. Wong, Hopital Henri Mondor
  • ,
  • Lisa Licitra, Thomas Jefferson University
  • ,
  • Jeffrey S. Tobias, Genolier Swiss Oncology Network
  • ,
  • Barbara Burtness, University of Oslo
  • ,
  • Maria Grazia Ghi, Université de Tours
  • ,
  • Ezra E.W. Cohen, Medical College of Wisconsin
  • ,
  • Cai Grau
  • Gregory Wolf, Centre Leon Berard
  • ,
  • Ricardo Hitt, Centre Antoine Lacassagne
  • ,
  • Renzo Corvò, Research and Education in Cancer
  • ,
  • Volker Budach, SUNY Downstate Medical Center
  • ,
  • Shaleen Kumar, Institut Curie
  • ,
  • Sarbani Ghosh Laskar, EORTC Headquarters
  • ,
  • Jean Jacques Mazeron, Spanish Head and Neck Cancer Cooperative Group
  • ,
  • Lai Ping Zhong, San Martino Hospital Genoa
  • ,
  • Werner Dobrowsky, Gustave Roussy
  • ,
  • Pirus Ghadjar, Johns Hopkins University
  • ,
  • Carlo Fallai, Université de Tours
  • ,
  • Branko Zakotnik, Centre Leon Berard
  • ,
  • Atul Sharma, Cancer Research UK
  • ,
  • René Jean Bensadoun, Hopital Henri Mondor
  • ,
  • Maria Grazia Ruo Redda, Rutgers Robert Wood Johnson and NJ Medical School
  • ,
  • Séverine Racadot, University Health Network
  • ,
  • George Fountzilas, SAKK Coordinating Center
  • ,
  • David Brizel, Centre Georges-Francois Leclerc
  • ,
  • Paolo Rovea, Kragulevac University Hospital
  • ,
  • Athanassios Argiris, University of Chicago
  • ,
  • Zoltán Takácsi Nagy, University of Groningen
  • ,
  • Ju Whei Lee, Centre Jean Perrin
  • ,
  • Catherine Fortpied, Centre Oscar Lambret
  • ,
  • Jonathan Harris, Emory University
  • ,
  • Jean Bourhis, Institut Saint Catherine, Stanford University
  • ,
  • Anne Aupérin, Cleveland Clinic Foundation, Institut Saint Catherine
  • ,
  • Pierre Blanchard, Cleveland Clinic Foundation, Institut Saint Catherine, University of Texas MD Anderson Cancer Center
  • ,
  • Jean Pierre Pignon, Cleveland Clinic Foundation, Institut Saint Catherine
  • ,
  • MACH-NC Collaborative Group

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.

OriginalsprogEngelsk
TidsskriftRadiotherapy and Oncology
Vol/bind156
Sider (fra-til)281-293
Antal sider13
ISSN0167-8140
DOI
StatusUdgivet - mar. 2021

Bibliografisk note

Funding Information:
We thank the trialists and the collaborative groups who agreed to share their data. The contents of this publication and methods used are solely the responsibility of the authors and do not necessarily represent the official views of the ECOG-ACRIN Cancer Research Group, and NRG Oncology. This research was funded by grants from Institut National du Cancer (Programme Hospitalier de Recherche Clinique) and Ligue Nationale Contre le Cancer .

Publisher Copyright:
© 2021 Elsevier B.V.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

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